title: [Evaluation of ADC mapping as an early predictor for tumor response to chemotherapy in recurrent glioma treated with bevacizumab/irinotecan: proof of principle].
abstract: OBJECTIVE
  The assessment of the radiological response of recurrent glioma is based on the Macdonald or RECIST criteria 8 to 10 weeks from the start of treatment. Magnetic resonance imaging using an apparent diffusion coefficient map may provide an earlier measure for predicting the response to therapy of recurrent glioma.
  
  
  METHODS
  Twelve patients with recurrent high-grade glioma were enrolled in a feasibility study of pretreatment MRI on day 1, intra-treatment MRI in week 3, and post-treatment MRI in week 12. Prognostically relevant ADC values (ADCprog) of each recurrent glioma at 3 weeks were calculated as a function of their pre- and intra-therapy ADC values (ADCpre - ADCintra = ADCprog). Because we hypothesized 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 a second time point as "progressive disease" (PD) and higher ADC values as "partial response" (PR). A change in ADCprog of less than 10 × 10⁻⁶mm² /sec was set as "stable disease" (SD). The ADCprog values were always calculated before the final scan after 3 months was performed. The readers were blinded to the future development of the tumor.
  
  
  RESULTS
  In 10 of the 12 patients we could correctly predict the tumor response to chemotherapy. One patient died before the three-month control, and one recurrent glioma did not develop as predicted. ADC mapping is found to predict patient response at 3 weeks from the start of treatment, revealing that early changes in tumor diffusion values could be used as a prognostic indicator also for chemotherapeutically treated recurrences of high-grade glioma.
authors.affiliation: Diagnostische Radiologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany. ar75@gmx.de
authors.forename: A
authors.initials: A
authors.lastname: Ringelstein
authors.forename: B
authors.initials: B
authors.lastname: Turowski
authors.forename: E R
authors.initials: ER
authors.lastname: Gizewski
authors.forename: J
authors.initials: J
authors.lastname: Schroeteler
authors.forename: M
authors.initials: M
authors.lastname: Rapp
authors.forename: A
authors.initials: A
authors.lastname: Saleh
authors.forename: R S
authors.initials: RS
authors.lastname: Lanzman
authors.forename: C
authors.initials: C
authors.lastname: Mathys
authors.forename: M
authors.initials: M
authors.lastname: Sabel
authors.forename: U
authors.initials: U
authors.lastname: Mödder
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D002166:Camptothecin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D003287:Contrast Media / Q000008:administration & dosage; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D005909:Glioblastoma / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D000077146:Irinotecan; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003287:Contrast Media; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000077146:Irinotecan; D005682:Gadolinium; D002166:Camptothecin