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. 2011 Apr;53(4):291-302.
doi: 10.1007/s00234-010-0808-0. Epub 2010 Dec 2.

ADC Histograms Predict Response to Anti-Angiogenic Therapy in Patients With Recurrent High-Grade Glioma

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Free PMC article

ADC Histograms Predict Response to Anti-Angiogenic Therapy in Patients With Recurrent High-Grade Glioma

Martha Nowosielski et al. Neuroradiology. .
Free PMC article

Abstract

Introduction: The purpose of this study is to evaluate apparent diffusion coefficient (ADC) maps to distinguish anti-vascular and anti-tumor effects in the course of anti-angiogenic treatment of recurrent high-grade gliomas (rHGG) as compared to standard magnetic resonance imaging (MRI).

Methods: This retrospective study analyzed ADC maps from diffusion-weighted MRI in 14 rHGG patients during bevacizumab/irinotecan (B/I) therapy. Applying image segmentation, volumes of contrast-enhanced lesions in T1 sequences and of hyperintense T2 lesions (hT2) were calculated. hT2 were defined as regions of interest (ROI) and registered to corresponding ADC maps (hT2-ADC). Histograms were calculated from hT2-ADC ROIs. Thereafter, histogram asymmetry termed "skewness" was calculated and compared to progression-free survival (PFS) as defined by the Response Assessment Neuro-Oncology (RANO) Working Group criteria.

Results: At 8-12 weeks follow-up, seven (50%) patients showed a partial response, three (21.4%) patients were stable, and four (28.6%) patients progressed according to RANO criteria. hT2-ADC histograms demonstrated statistically significant changes in skewness in relation to PFS at 6 months. Patients with increasing skewness (n = 11) following B/I therapy had significantly shorter PFS than did patients with decreasing or stable skewness values (n = 3, median percentage change in skewness 54% versus -3%, p = 0.04).

Conclusion: In rHGG patients, the change in ADC histogram skewness may be predictive for treatment response early in the course of anti-angiogenic therapy and more sensitive than treatment assessment based solely on RANO criteria.

Figures

Fig. 1
Fig. 1
Skewness. Positive skewness indicates that the majority of the values lie to the left of the mean; negative skewness indicates that the majority of the values lie to the right of the mean
Fig. 2
Fig. 2
ADC change. ADC in progressors and non-progressors over a period of 6 months. Median change in ADC in progressors (n=11) is −6.8% (range −37.3–10.3%). Median change in ADC in non-progressors (n=3) is 7.9% (range: 0.7–33%). There is a statistically significant difference between the two groups (p=0.04)
Fig. 3
Fig. 3
ADC histogram skewness. ADC histogram skewness in progressors and non-progressors during a period of 6 months. Median change in skewness for progressors (n=11) is 54% (range, −30–2,548%). Median change in skewness for non-progressors (n=3) is −3% (range, −44–14%). There is a statistically significant difference between the two groups (p=0.04)
Fig. 4
Fig. 4
Patient no. 7 from Table 2. a, e, i, l, p, t T1 post-contrast MRI sequence, in blue: segmented T1 post-contrast volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. b, f, j, m, q, u T2 MRI sequence prior to B/I treatment, in magenta: segmented T2 volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of therapy. c, g, k, n, r, v ADC map, in small; segmented T2 volume, registered to corresponding ADC maps at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. d, h, l, o, s, w histogram of segmented T2 volume; gray scale count gives the number of gray scales for the T2 volume
Fig. 5
Fig. 5
Patient no. 12 from Table 2. a, e, i, l, p, t T1 post-contrast MRI sequence, in blue: segmented T1 post-contrast volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. b, f, j, m, q, u T2 MRI sequence prior to B/I treatment, in magenta: segmented T2 volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of therapy. c, g, k, n, r, v ADC map, in small; segmented T2 volume, registered to corresponding ADC maps at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. d, h, l, o, s, w histogram of segmented T2 volume; gray scale count gives the number of gray scales for the T2 volume
Fig. 5
Fig. 5
Patient no. 12 from Table 2. a, e, i, l, p, t T1 post-contrast MRI sequence, in blue: segmented T1 post-contrast volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. b, f, j, m, q, u T2 MRI sequence prior to B/I treatment, in magenta: segmented T2 volume at baseline, 12, 16, 28, 40, and 52 weeks after commencement of therapy. c, g, k, n, r, v ADC map, in small; segmented T2 volume, registered to corresponding ADC maps at baseline, 12, 16, 28, 40, and 52 weeks after commencement of B/I therapy. d, h, l, o, s, w histogram of segmented T2 volume; gray scale count gives the number of gray scales for the T2 volume

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