Radiological Imaging after Treatment in High-Grade Glial Tumor

Year 2015, Volume: 40 Issue: 4, 642 - 653, 02.10.2015

Özlem Alkan

https://doi.org/10.17826/cutf.93167

Abstract

High-grade glial tumors are the most common primary brain tumor in adults. The current standard of care for high-grade glial tumors includes surgical resection followed by combination of radiation with temazolomide treatment and adjuvant temozolomide. The Macdonald Criteria are currently the most widely used guideline for assessing response to therapy in patients with high-grade glial tumors. These are based on the size of the contrast-enhancing lesion in MR imaging. Recently, nontumoral changes in enhancement have been found. It is now clear that evaluation of gadolinium enhancement alone is not adequate to characterize tumor regression or progression. MR diffusion, MR perfusion, MR spectroscopy, and PET imaging will be important adjuncts to traditional imaging for tumor assessment. We review MR imaging findings following high-grade tumor treatment.

Keywords

High-grade glial tumour, MR, Diffusion MR, Perfusion MR, MR spectroscopy

Yüksek Dereceli Glial Tümörlerde Tedavi Sonrası Radyolojik Görüntüleme

Abstract

Yüksek dereceli glial tümörler erişkinlerde en sık görülen beyin tümörleridir. Yüksek dereceli glial tümörlerde güncel tedavi yaklaşımı cerrahi rezeksiyonu takiben, temazolomide ve radyoterapinin kombinasyonu ve takiben adjuvan temazolomide şeklindedir. Macdonald kriterleri yüksek dereceli glial tümörlerde tedaviye yanıt değerlendirmesinde yaygın olarak kullanılmaktaydı. Bu kriterler MR görüntülerde kontrast tutan lezyonun boyutuna dayanıyordu. Bu günlerde tümoral olmayan kontrastlanmalar saptandı. Tumor progresyonu ya da regresyonunu değerlendirmede kontrastlı görüntüler yetersiz kalmaktadır. MR difüzyon, MR perfüzyon, MR spektroskopi ve PET görüntüleme tümör değerlendirmesinde konvansiyonel MR görüntülere yardımcı olmaktadır. Biz bu makalede yüksek dereceli glial tümörlerde tedavi sonrası MR görüntüleme bulgularını gözden geçirdik.

Keywords

Yüksek dereceli glial tümör, Difüzyon MR, Perfüzyon MR, MR spektroskopi

References

• Hygino da Cruz LC, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG. Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma.AJNR. 2011;32:1978-85.
• Kumar AJ, Leeds NE, Fuller GN, Van Tassel P, Maor MH, Sawaya RE, Levin VA. Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology. 2000;217:377-84.
• Ulmer S, Braga TA, Barker FG, Lev MH, Gonzalez RG, Henson JW.Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology. 2006 ;67:1668-70.
• Sundgren PC. MR spectroscopy in radiation injury. AJNR. 2009;30:1469-76.
• Ricci PE, Karis JP, Heiserman JE, Fram EK, Bice AN, Drayer BP.Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography? AJNR Am J Neuroradiol. 1998;19:407-13.
• Mangla R, Singh G, Ziegelitz D, Milano MT, Korones DN, Zhong J, Ekholm SE. Changes in relative cerebral blood volume 1 month after radiation- temozolomide therapy can help predict overall survival in patients with glioblastoma. Radiology. 2010;256:575-84.
• Fatterpekar GM, Galheigo D, Narayana A, Johnson G, Knopp E. Treatment-related change versus tumor recurrence in high-grade gliomas: a diagnostic conundrum--use of dynamic susceptibility contrast- enhanced (DSC) perfusion MRI. AJR. 2012;198:19- 26.
• Brandsma D, van den Bent MJ. Pseudoprogression and pseudoresponse in the treatment of gliomas.Curr Opin Neurol. 2009;22:633-8.
• Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group.J Clin Oncol. 2010;28:1963-72.
• Chu HH, Choi SH, Ryoo I, Kim SC, Yeom JA, Shin H, Jung SC, Lee AL, Yoon TJ, Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide: comparison study of standard and high-b-value diffusion-weighted imaging. Radiology. 2013;269:831-40.
• Pope WB, Kim HJ, Huo J, Alger J, Brown MS, Gjertson D, Sai V, Young JR, Tekchandani L, Cloughesy T, Mischel PS, Lai A, Nghiemphu P, Rahmanuddin S, Goldin J. Recurrent glioblastoma multiforme: ADC histogram analysis predicts response to bevacizumab treatment. Radiology. 2009;252:182-9.
• Mong S, Ellingson BM, Nghiemphu PL, Kim HJ, Mirsadraei L, Lai A, Yong W, Zaw TM, Cloughesy TF, Pope WB. Persistent diffusion-restricted lesions in bevacizumab-treated malignant gliomas are associated with improved survival compared with matched controls. 2012;33:1763-70.
• Sawlani RN, Raizer J, Horowitz SW, Shin W, Grimm SA, Chandler JP, Levy R, Getch C, Carroll TJ. Glioblastoma: a method for predicting response to antiangiogenic chemotherapy by using MR perfusion imaging--pilot study. Radiology. 2010;255:622-8.
• Macdonald DR, Cascino TL, Schold SC, Cairncross JG.Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8:1277-80.