title: Outcome of radiosurgery for recurrent malignant gliomas: assessment of treatment response using relative cerebral blood volume.
abstract: Gamma knife radiosurgery (GKS) is efficacious for treating recurrent malignant gliomas as a salvage treatment. However, contrast enhancement alone on MR imaging remains difficult to determine the treatment response following GKS. The purpose of this study was to evaluate the radiosurgical effect for recurrent malignant gliomas and to clarify if relative cerebral blood volume (rCBV) derived from dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion MR imaging could represent the treatment response. Between March 2006 and December 2008, 38 patients underwent GKS for recurrent malignant gliomas. Before and after GKS, DSC perfusion MR imaging datasets were retrospectively reprocessed and regions of interest were drawn around the contrast-enhancing region targeted with GKS. DSC-perfusion MR scans were assessed at a regular interval of two months. Following GKS for the recurrent lesions, MR images showed response (stable disease or partial response) in 26 of 38 patients (68.4 %) at post-GKS 2 months and 18 of 38 patients (47.3 %) at post-GKS 4 months. Initial mean rCBV value was 2.552 (0.586-6.178) at the pre-GKS MRI. In the response group, mean rCBV value was significantly decreased (P < 0.05) at the follow up of 2 and 4 months. However, in the treatment-failure group, mean rCBV value had no significant change. We suggest that GKS is an alternative treatment choice for the recurrent glioma. DSC-perfusion MR images are helpful to predict the treatment response after GKS.
authors.affiliation: Department of Neurosurgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea.
authors.forename: Hong Rye
authors.initials: HR
authors.lastname: Kim
authors.forename: Se-Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Jung-Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Seol
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Kwan
authors.initials: K
authors.lastname: Park
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Doo-Sik
authors.initials: DS
authors.lastname: Kong
mesh_terms: D000328:Adult; D000368:Aged; D001810:Blood Volume; D001811:Blood Volume Determination / Q000379:methods; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies