Kartik Kesavabhotla, Presenter: Nothing to Disclose

Sirish Kishore MD, Abstract Co-Author: Nothing to Disclose

Ilhami Kovanlikaya MD, Abstract Co-Author: Nothing to Disclose

John A. Boockvar MD, Abstract Co-Author: Nothing to Disclose

Apostolos John Tsiouris MD, Abstract Co-Author: Research Consultant, BioClinica, Inc

Imithri Bodhinayake, Abstract Co-Author: Nothing to Disclose

Matei Banu, Abstract Co-Author: Nothing to Disclose

Malte Ottenhausen, Abstract Co-Author: Nothing to Disclose

At our institution, we have been conducting phase I and II studies of super-selective intra-arterial cerebral infusion (SIACI) of bevacizumab (BV) in the setting of recurrent glioblastoma multiforme (GBM). BV is known to reduce vessel permeability, which contributes to changes in enhancement features and potentially confounds the relationship between enhancement and tumor biology. Hence, the ability of conventional MRI to determine tumor response, progression, and post-treatment effects is limited. Here we have begun to evaluate the potential for using dynamic susceptibility contrast imaging (DSC-MRI)-derived maps of relative cerebral blood volume (rCBV) to determine early GBM tumor response to super-selective intra-arterial BV treatment. These rCBV changes will then be correlated with tumor progression and patient survival.

Forty adult patients with recurrent WHO grade IV glioma from an ongoing serial Phase I/II study of SIACI of BV were retrospectively studied. Pre- and post BV treatment gadolinium-enhanced brain DSC-MRI were done within the time frame of a few days prior to and 3-5 weeks after intra-arterial infusion of BV. Functional rCBV maps have been obtained on a GE Advantage Workstation (AW) V4.3 running functools MR perfusion software. Two distinct regions of interest (ROIs) were chosen from the rCBV maps: 1) area of highest rCBV in tumor region and 2) normal appearing white matter (NAWM) in the contralateral side which was used to normalize rCBV maps.

Preliminary results from 18 patients in the cohort looking at normalized rCBV have been promising. The median percentage change in normalized rCBV at 1 month post-SIACI BV is -39.3% for patients with survival greater than 100 days post-treatment, -3.6% for patients who survived less than 100 days, and -38.8% overall. Of the 13 patients who remained in the trial without further SIACI treatments, the Pearson correlation coefficient between BV dose and normalized rCBV change at 1 month was -.80 (n = 13, p-value of .001).

Diffusion susceptibility perfusion imaging demonstrates super-selective intra-arterial cerebral infusion of bevacizumab results in a dose-dependent reduction of relative tumor blood volume.

By looking at local rCBV changes following intra-arterial bevacizumab treatment, this study aims to gain further insight into predicting glioblastoma tumor response and ultimately patient survival.

Kesavabhotla, K, Kishore, S, Kovanlikaya, I, Boockvar, J, Tsiouris, A, Bodhinayake, I, Banu, M, Ottenhausen, M, The Role of Diffusion Susceptibility Perfusion Imaging in Assessing Recurrent Glioblastoma Multiforme Early Response to Superselective Intra-arterial Bevacizumab Therapy.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13027958.html