title: Preliminary experience with diffusion tensor imaging before and after re-irradiation treatments in children with progressive diffuse pontine glioma.
abstract: OBJECTIVE
  The purpose of this study is to evaluate quantitative changes in diffusion tensor imaging (DTI) tractography and fractional anisotropy (FA) of the pons along with clinical correlation, in patients who receive re-irradiation for progressive diffuse intrinsic pontine glioma (DIPG).
  
  
  METHODS
  A retrospective case review of children with progressive DIPG who received re-irradiation at our institution from 2007 to 2011 after approval from the Institutional Review Board was performed. Tractography analysis and FA were analyzed pre and post-re-irradiation, and correlation with clinical features and MR imaging was performed.
  
  
  RESULTS
  DTI analysis showed reduced values of FA on tumor progression. Increase in the FA values was noted after re-irradiation in these patients. This correlated with clinical improvement. These changes were concordant with the 3D tractography analysis which showed better visualization of the corticospinal tracts as they course through brainstem and posterior transverse pontine fibers following re-irradiation.
  
  
  CONCLUSIONS
  Serial changes in the FA values using DTI could provide clinically more correlative information in patients with progressive DIPG, who receive re-irradiation. Though the use and results of this modality has been reported in the newly diagnosed DIPG before, evaluation of DTI in children who receive re-irradiation for progressive DIPG has not been reported earlier. Though limited by the small sample size and treatment variability, this study for the first time shows the preliminary experience, potential, and likely efficacy of complementing DTI analysis to routine neuroimaging also in patients re-irradiated for progressive DIPG to better assess treatment response.
authors.affiliation: Department of Pediatrics, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 87, Houston, TX, 77479, USA, skhatua@mdanderson.org.
authors.forename: Soumen
authors.initials: S
authors.lastname: Khatua
authors.forename: Ping
authors.initials: P
authors.lastname: Hou
authors.forename: Ravi
authors.initials: R
authors.lastname: Bodiwala
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolff
authors.forename: Jackson
authors.initials: J
authors.lastname: Hamilton
authors.forename: Shekhar
authors.initials: S
authors.lastname: Patil
authors.forename: Wafik
authors.initials: W
authors.lastname: Zaky
authors.forename: Anita
authors.initials: A
authors.lastname: Mahajan
authors.forename: Leena
authors.initials: L
authors.lastname: Ketonen
mesh_terms: D016880:Anisotropy; D020295:Brain Stem Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D065837:Middle Cerebellar Peduncle / Q000473:pathology*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies