Ringelstein A, Turowski B, Gizewski E R, Schroeteler J, Rapp M, Saleh A, Lanzman R S, Mathys C, Sabel M, Mödder U
Diagnostische Radiologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
Rofo. 2010 Oct;182(10):868-72. doi: 10.1055/s-0029-1245570. Epub 2010 Aug 25.
The assessment of the radiological response of recurrent glioma is based on the Macdonald or RECIST criteria 8 to 10 weeks from the start of treatment. Magnetic resonance imaging using an apparent diffusion coefficient map may provide an earlier measure for predicting the response to therapy of recurrent glioma.
Twelve patients with recurrent high-grade glioma were enrolled in a feasibility study of pretreatment MRI on day 1, intra-treatment MRI in week 3, and post-treatment MRI in week 12. Prognostically relevant ADC values (ADCprog) of each recurrent glioma at 3 weeks were calculated as a function of their pre- and intra-therapy ADC values (ADCpre - ADCintra = ADCprog). Because we hypothesized that smaller ADC values correlate with less Brownian motion of water molecules in the extracellular space and that a higher cell density may restrain this water diffusion, we set smaller ADC values at a second time point as "progressive disease" (PD) and higher ADC values as "partial response" (PR). A change in ADCprog of less than 10 × 10⁻⁶mm² /sec was set as "stable disease" (SD). The ADCprog values were always calculated before the final scan after 3 months was performed. The readers were blinded to the future development of the tumor.
In 10 of the 12 patients we could correctly predict the tumor response to chemotherapy. One patient died before the three-month control, and one recurrent glioma did not develop as predicted. ADC mapping is found to predict patient response at 3 weeks from the start of treatment, revealing that early changes in tumor diffusion values could be used as a prognostic indicator also for chemotherapeutically treated recurrences of high-grade glioma.
复发性胶质瘤放射学反应的评估是基于治疗开始后8至10周的麦克唐纳或实体瘤疗效评价标准（RECIST）。使用表观扩散系数图的磁共振成像可能为预测复发性胶质瘤的治疗反应提供更早的指标。
12例复发性高级别胶质瘤患者参加了一项可行性研究，在第1天进行治疗前磁共振成像（MRI），第3周进行治疗中MRI，第12周进行治疗后MRI。将每个复发性胶质瘤在3周时的预后相关表观扩散系数值（ADCprog）计算为其治疗前和治疗中表观扩散系数值（ADCpre - ADCintra = ADCprog）的函数。因为我们假设较小的ADC值与细胞外空间水分子的布朗运动减少相关，并且较高的细胞密度可能抑制这种水扩散，所以我们将第二个时间点较小的ADC值设定为“疾病进展”（PD），较高的ADC值设定为“部分缓解”（PR）。ADCprog变化小于10×10⁻⁶mm² /秒被设定为“疾病稳定”（SD）。ADCprog值总是在3个月后的最终扫描前计算。阅片者对肿瘤的未来发展情况不知情。
12例患者中有10例，我们能够正确预测肿瘤对化疗的反应。1例患者在3个月的对照检查前死亡，1例复发性胶质瘤未按预测发展。发现ADC图可在治疗开始后3周预测患者反应，表明肿瘤扩散值的早期变化也可作为高级别胶质瘤化疗后复发的预后指标。
