title: Dynamic Susceptibility Contrast-Enhanced MR Perfusion Imaging in Assessing Recurrent Glioblastoma Response to Superselective Intra-Arterial Bevacizumab Therapy.
abstract: OBJECTIVE
  Recurrent glioblastoma currently has no established standard of care. We evaluated the response of recurrent glioblastoma to superselective intra-arterial cerebral infusion of bevacizumab by using dynamic susceptibility contrast-enhanced MR perfusion imaging. We hypothesized that treatment response would be associated with decreased relative CBV and relative CBF.
  
  
  METHODS
  Patients were accrued for this study from larger ongoing serial Phase I/II trials. Twenty-five patients (14 men, 11 women; median age, 55 years) were analyzed. Four distinct ROIs were chosen: 1) normal-appearing white matter on the contralateral side, 2) the location of the highest T1 enhancement in the lesion (maximum enhancing), 3) the location of highest relative CBV in the lesion (maximum relative CBV), and 4) nonenhancing T2 hyperintense signal abnormality surrounding the tumor (nonenhancing T2 hyperintensity).
  
  
  RESULTS
  There was a statistically significant median percentage change of -32.34% (P= .001) in relative CBV in areas of maximum relative CBV following intra-arterial bevacizumab therapy. There was also a statistically significant median percentage decrease in relative CBF of -30.67 (P= .001) and -27.25 (P= .037) in areas of maximum relative CBV and maximum tumor enhancement, respectively. Last, a trend toward statistical significance for increasing relative CBV in nonenhancing T2 hyperintense areas (median percent change, 30.04;P= .069) was noted.
  
  
  CONCLUSIONS
  Dynamic susceptibility contrast-enhanced MR perfusion imaging demonstrated a significant decrease in tumor perfusion metrics within recurrent glioblastomas in response to superselective intra-arterial cerebral infusion of bevacizumab; however, these changes did not correlate with time to progression or overall survival.
authors.affiliation: From the Departments of Neurological Surgery (R.S., Z.Z.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-3651-5415
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Neurological Surgery (K.K.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: K
authors.identifier: http://orcid.org/0000-0001-5895-6935
authors.initials: K
authors.lastname: Kesavabhotla
authors.affiliation: Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York.
authors.forename: S A
authors.identifier: http://orcid.org/0000-0001-9522-5859
authors.initials: SA
authors.lastname: Kishore
authors.affiliation: From the Departments of Neurological Surgery (R.S., Z.Z.).
authors.forename: Z
authors.identifier: http://orcid.org/0000-0001-5774-3823
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York.
authors.forename: A J
authors.identifier: http://orcid.org/0000-0002-9281-716X
authors.initials: AJ
authors.lastname: Tsiouris
authors.affiliation: Departments of Radiology (C.G.F.).
authors.forename: C G
authors.identifier: http://orcid.org/0000-0002-4565-2614
authors.initials: CG
authors.lastname: Filippi
authors.affiliation: Neurological Surgery (J.A.B.), Lenox Hill Hospital, Hofstra-North Shore-LIJ School of Medicine, New York, New York.
authors.forename: J A
authors.identifier: http://orcid.org/0000-0002-8137-6303
authors.initials: JA
authors.lastname: Boockvar
authors.affiliation: Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York ilk2002@med.cornell.edu.
authors.forename: I
authors.identifier: http://orcid.org/0000-0001-6339-9862
authors.initials: I
authors.lastname: Kovanlikaya