Adrian Stefan Ringelstein MD, Presenter: Nothing to Disclose

Bernd Turowski, Abstract Co-Author: Nothing to Disclose

Juliane Schroeteler, Abstract Co-Author: Nothing to Disclose

Marion Rapp, Abstract Co-Author: Nothing to Disclose

Elke R Gizewski MD, PhD, Abstract Co-Author: Nothing to Disclose

Rotem Shlomo Lanzman MD, Abstract Co-Author: Nothing to Disclose

Andreas Saleh MD, Abstract Co-Author: Nothing to Disclose

Michael Sabel, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

Assessment of radiologic response for recurrent glioma utilizes the Macdonald criteria 8 to 10 weeks from the start of treatment. Diffusion magnetic resonance imaging using a functional diffusion map may provide an earlier measure to predict response to therapy of recurrent glioma.

Twelve patients with recurrent high-grade glioma were enrolled onto a feasibility study of pretreatment MRI at day 1, intratreatment MRI at week 3, and posttreatment MRI at week 10. Prognostic relevant ADC values (ADCprog) of each recurrent glioma at 3 weeks were calculated as a function of their pre- and intratherapy ADC values (ADCpre – ADCintra = ADCprog). Because we hypothesised 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 second time point as “progressive disease” (PD) and higher ADC values as “partial response” (PR). An ADCprog - change of less than 10 was set as “stable disease” (SD). The ADCprog values were always calculated before the final scan after 3 month was performed. So the readers were blinded for the future development of the tumour.

Eight patients were treated with Bevacizumab/Irinotecane, four Patients were treated according to the Stupp-Scheme. In 10 of the 12 patients we could correctly predict the tumour response to the chemotherapy. One patient died before the three month control, one recurrent glioma did not develop as predicted. The ADC mapping is found to predict patient response at 3 weeks from the start of treatment, revealing that early changes in tumour diffusion values could be used as a prognostic indicator also for chemotherapeutically treated recurrences of high-grade glioma.

On the basis of a small patient population, this feasibility study shows that ADC analysis could provide an early biomarker for predicting treatment response also in recurrent brain tumours.

The method could lead to an imaging depending change of the therapeutical regime by detecting non-responder already 3 weeks after the start of therapy in recurrent glioma

Ringelstein, A, Turowski, B, Schroeteler, J, Rapp, M, Gizewski, E, Lanzman, R, Saleh, A, Sabel, M, et al, 0, Evaluation of ADC-Mapping as an Early Predictor for Tumour Response to Chemotherapy in Recurrent Glioma.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014384.html