title: Early detection of response to radiation therapy in patients with brain malignancies using conventional and high b-value diffusion-weighted magnetic resonance imaging.
abstract: OBJECTIVE
  To study the feasibility of using diffusion-weighted magnetic resonance imaging (DWMRI), which is sensitive to the diffusion of water molecules in tissues, for detection of early tumor response to radiation therapy; and to evaluate the additional information obtained from high DWMRI, which is more sensitive to low-mobility water molecules (such as intracellular or bound water), in increasing the sensitivity to response.
  
  
  METHODS
  Standard MRI and DWMRI were acquired before and at regular intervals after initiating radiation therapy for 10 malignant brain lesions in eight patients.
  
  
  RESULTS
  One week posttherapy, three of six responding lesions showed an increase in the conventional DWMRI parameters. Another three responding lesions showed no change. Four nonresponding lesions showed a decrease or no change. The early change in the diffusion parameters was enhanced by using high DWMRI. When high DWMRI was used, all responding lesions showed increase in the diffusion parameter and all nonresponding lesions showed no change or decrease. Response was determined by standard MRI 7 weeks posttherapy. The changes in the diffusion parameters measured 1 week after initiating treatment were correlated with later tumor response or no response (P <.006). This correlation was increased to P <.0006 when high DWMRI was used.
  
  
  CONCLUSIONS
  The significant correlation between changes in diffusion parameters 1 week after initiating treatment and later tumor response or no response suggests the feasibility of using DWMRI for early, noninvasive prediction of tumor response. The ability to predict response may enable early termination of treatment in nonresponding patients, prevent additional toxicity, and allow for early changes in treatment.
authors.affiliation: Advanced Technology Center, Neurosurgery Department, Oncology Institute, Tel-Hashomer, Israel. yael@tauphy.tau.ac.il
authors.forename: Yael
authors.initials: Y
authors.lastname: Mardor
authors.forename: Raphael
authors.initials: R
authors.lastname: Pfeffer
authors.forename: Roberto
authors.initials: R
authors.lastname: Spiegelmann
authors.forename: Yiftach
authors.initials: Y
authors.lastname: Roth
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Maier
authors.forename: Ouzi
authors.initials: O
authors.lastname: Nissim
authors.forename: Raanan
authors.initials: R
authors.lastname: Berger
authors.forename: Ami
authors.initials: A
authors.lastname: Glicksman
authors.forename: Jacob
authors.initials: J
authors.lastname: Baram
authors.forename: Arie
authors.initials: A
authors.lastname: Orenstein
authors.forename: Jack S
authors.initials: JS
authors.lastname: Cohen
authors.forename: Thomas
authors.initials: T
authors.lastname: Tichler
mesh_terms: D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy*; D005240:Feasibility Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome