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3-Dimensional magnetic resonance spectroscopic imaging at 3 Tesla for early response assessment of glioblastoma patients during external beam radiation therapy
Journal article   Open access   Peer reviewed

3-Dimensional magnetic resonance spectroscopic imaging at 3 Tesla for early response assessment of glioblastoma patients during external beam radiation therapy

Manickam Muruganandham, Patrick P Clerkin, Brian J Smith, Carryn M Anderson, Ann Morris, Aristides A Capizzano, Vincent Magnotta, Sarah M McGuire, Mark C Smith, John E Bayouth, …
International journal of radiation oncology, biology, physics, Vol.90(1), pp.181-189
09/01/2014
DOI: 10.1016/j.ijrobp.2014.05.014
PMCID: PMC4183193
PMID: 24986746
url
https://www.ncbi.nlm.nih.gov/pmc/articles/4183193View
Open Access

Abstract

To evaluate the utility of 3-dimensional magnetic resonance (3D-MR) proton spectroscopic imaging for treatment planning and its implications for early response assessment in glioblastoma multiforme. Eighteen patients with newly diagnosed, histologically confirmed glioblastoma had 3D-MR proton spectroscopic imaging (MRSI) along with T2 and T1 gadolinium-enhanced MR images at simulation and at boost treatment planning after 17 to 20 fractions of radiation therapy. All patients received standard radiation therapy (RT) with concurrent temozolomide followed by adjuvant temozolomide. Imaging for response assessment consisted of MR scans every 2 months. Progression-free survival was defined by the criteria of MacDonald et al. MRSI images obtained at initial simulation were analyzed for choline/N-acetylaspartate ratios (Cho/NAA) on a voxel-by-voxel basis with abnormal activity defined as Cho/NAA ≥2. These images were compared on anatomically matched MRSI data collected after 3 weeks of RT. Changes in Cho/NAA between pretherapy and third-week RT scans were tested using Wilcoxon matched-pairs signed rank tests and correlated with progression-free survival, radiation dose and location of recurrence using Cox proportional hazards regression. After a median follow-up time of 8.6 months, 50% of patients had experienced progression based on imaging. Patients with a decreased or stable mean or median Cho/NAA values had less risk of progression (P<.01). Patients with an increase in mean or median Cho/NAA values at the third-week RT scan had a significantly greater chance of early progression (P<.01). An increased Cho/NAA at the third-week MRSI scan carried a hazard ratio of 2.72 (95% confidence interval, 1.10-6.71; P=.03). Most patients received the prescription dose of RT to the Cho/NAA ≥2 volume, where recurrence most often occurred. Change in mean and median Cho/NAA detected at 3 weeks was a significant predictor of early progression. The potential impact for risk-adaptive therapy based on early spectroscopic findings is suggested.
 Choline - metabolism Follow-Up Studies Dacarbazine - therapeutic use Humans Middle Aged Imaging, Three-Dimensional - methods Magnetic Resonance Imaging - methods Gadolinium Male Glioblastoma - radiotherapy Brain Neoplasms - metabolism Time Factors Matched-Pair Analysis Dacarbazine - analogs & derivatives Biomarkers, Tumor - metabolism Adult Female Glioblastoma - metabolism Brain Neoplasms - radiotherapy Radiotherapy Dosage Chemoradiotherapy - methods Magnetic Resonance Spectroscopy - methods Neoplasm Recurrence, Local - metabolism Biomarkers, Tumor - analysis Proportional Hazards Models Brain Neoplasms - drug therapy Disease Progression Antineoplastic Agents, Alkylating - therapeutic use Disease-Free Survival Contrast Media Aspartic Acid - metabolism Aged Aspartic Acid - analogs & derivatives Glioblastoma - drug therapy

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