title: Metabolic response of glioblastoma to superselective intra-arterial cerebral infusion of bevacizumab: a proton MR spectroscopic imaging study.
abstract: OBJECTIVE
  SIACI of bevacizumab has emerged as a promising novel therapy in the treatment of recurrent GB. This study assessed the potential of (1)H-MRS as an adjunctive technique in detecting metabolic changes reflective of antiproliferative effects of targeted infusion of bevacizumab in the treatment of GB.
  
  
  METHODS
  Eighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included. Concurrent MR imaging and (1)H-MRS scans were performed before and after treatment. Five distinct morphologic ROIs were evaluated for structural and metabolic changes on MR imaging and (1)H-MRS, which included enhancing, nonenhancing T2 hyperintense signal abnormality, and multiple control regions. Pre- and post-SIACI of bevacizumab peak areas for NAA, tCho, tCr, as well as tCho/tCr and tCho/NAA ratios, were derived for all 5 ROIs and compared using the Wilcoxon signed-rank test.
  
  
  RESULTS
  A significant median decrease of 25.99% (range -55.76 to 123.94; P = .006) in tCho/NAA was found post-SIACI of bevacizumab relative to pretreatment values in regions of enhancing disease. A trend-level significant median decrease of 6.45% (range -23.71 to 37.67; P = .06) was noted in tCho/NAA posttreatment in regions of nonenhancing T2-hyperintense signal abnormality.
  
  
  CONCLUSIONS
  The results of this (1)H-MRS analysis suggest that GB treatment with SIACI of bevacizumab may be associated with a direct antiproliferative effect, as demonstrated by significant reductions of tCho/NAA after the intervention.
authors.affiliation: Departments of Neuroradiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: J Y
authors.initials: JY
authors.lastname: Jeon
authors.forename: I
authors.initials: I
authors.lastname: Kovanlikaya
authors.forename: J A
authors.initials: JA
authors.lastname: Boockvar
authors.forename: X
authors.initials: X
authors.lastname: Mao
authors.forename: B
authors.initials: B
authors.lastname: Shin
authors.forename: J
authors.initials: J
authors.lastname: K Burkhardt
authors.forename: K
authors.initials: K
authors.lastname: Kesavabhotla
authors.forename: P
authors.initials: P
authors.lastname: Christos
authors.forename: H
authors.initials: H
authors.lastname: Riina
authors.forename: D C
authors.initials: DC
authors.lastname: Shungu
authors.forename: A J
authors.initials: AJ
authors.lastname: Tsiouris
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D000068258:Bevacizumab; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000378:metabolism*; D002536:Cerebral Arteries; D002794:Choline / Q000378:metabolism; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D007261:Infusions, Intra-Arterial; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011522:Protons; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011522:Protons; D000068258:Bevacizumab; D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline