title: Decrease in the apparent diffusion coefficient in peritumoral edema for the assessment of recurrent glioblastoma treated by bevacizumab.
abstract: OBJECTIVE
  Anti-edema effect of bevacizumab was evaluated using the apparent diffusion coefficient (ADC) of peritumoral edema associated with regional cerebral blood flow (rCBV) of the tumor.
  
  
  METHODS
  Nine patients with recurrent glioblastoma were treated using bevacizumab for 4 ∼ 36 months (average 12 months). MRI was performed every 2 months. For each MRI, ADC value, Gd-enhanced area on T1 imaging, area of peritumoral edema on T2 imaging, and rCBV on perfusion imaging were measured. ADC and rCBV values were determined by the use of regions of interest positioned in areas of high signal intensity, as seen on T2-weighted images and ADC maps.
  
  
  RESULTS
  After 2 months of bevacizumab treatment, ADC values and rCBV decreased 49 and 32 % respectively, associated with marked diminishment of the Gd-enhanced area compared with pretreatment. After 6 months, in 5 of the 9 cases, the Gd-enhanced area appeared again with no change in the ADC value and rCBV. In the other four cases, the Gd-enhanced area as well as the ADC value and rCBV returned to the initial status.
  
  
  CONCLUSIONS
  The anti-edema effect of bevacizumab for treatment of recurrent glioblastoma that was demonstrated by decreased ADC values and rCBV was dramatic and -prolonged at 6 months even with tumor progression.
authors.affiliation: Department of Neurosurgery, University of Tsukuba, Tsukuba city, Ibaraki, Japan. shingo4@md.tsukuba.ac.jp
authors.forename: Shingo
authors.initials: S
authors.lastname: Takano
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kimu
authors.forename: Kyoji
authors.initials: K
authors.lastname: Tsuda
authors.forename: Satoru
authors.initials: S
authors.lastname: Osuka
authors.forename: Kei
authors.initials: K
authors.lastname: Nakai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishikawa
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Akutsu
authors.forename: Masahide
authors.initials: M
authors.lastname: Matsuda
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology*; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D004058:Diffusion; D005682:Gadolinium; D005909:Glioblastoma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D013997:Time Factors
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005682:Gadolinium