Imaging response criteria for recurrent gliomas treated with bevacizumab: Role of diffusion weighted imaging as an imaging biomarker

摘要

The purpose of this study was to assess the usefulness of diffusion weighted imaging as an additional imaging biomarker for treatment response in recurrent/progressive malignant gliomas treated with bevacizumab alone or in combination with other chemotherapeutic agents. Twenty patients treated with bevacizumab alone or concurrent chemotherapy were followed up with serial MR imaging. Volume and ADC values of contrast enhancing lesion (CEL_vol, CEL_ADC) and also of non-enhancing lesion (NEL_vol, NEL_ADC) were obtained. CEL_vol showed a progressive decrease in non-progressors with a median percentage change of −73.2% (P = 0.001) as compared to −33.4% for progressors by 1 year/last imaging (P = 0.382). NEL_vol also showed a decrease in non-progressors on follow up imaging though only significant for 3 months follow up (P = 0.042). In progressors, CEL_vol and NEL_vol showed initial decrease followed by slight increase by 1 year/last imaging though not significant (P value of 0.382 and 0.46, respectively). CEL_ADC and NEL_ADC in non-progressors did not show any statistically significant change though there was slight trend for positive percent change especially for CEL_ADC by 1 year/last imaging follow up study (P value of 0.077 and 0.339, respectively). Progressors showed a progressive negative percent change of CEL_ADC and NEL_ADC. In progressors, NEL_ADC decreased at 6 weeks (P = 0.054), 3 months (P = 0.023) and 1 year/last (P = 0.078) as compared to baseline study and was also statistically significant as compared to non-progressors at 6 weeks (P = 0.047) and 3 months (P = 0.025). CEL_ADC and NEL_ADC appear to follow different trends over time for non-progressors and progressors with a stable to slightly progressive increase in non-progressors and a progressive decrease in progressors, especially early on. These findings suggest that DWI may be used as an additional imaging biomarker for early treatment response. Keywords Diffusion - ADC - Avastin - Bevacizumab - Recurrent glioma