title: Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib.
abstract: OBJECTIVE
  The role of perfusion imaging in the management of pediatric high grade glioma is unclear. We evaluated the ability of dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) to determine grade, evaluate post-treatment response and predict treatment failure.
  
  
  METHODS
  In this study 22 patients with high-grade glioma underwent biopsy and were treated with concurrent and sequential radiotherapy and erlotinib as part of a phase I/II clinical trial (NCT00124657). Preradiotherapy, immediate postradiotherapy, 6‑month and treatment failure DSC MR images were reviewed, registered, and processed for the ratio of cerebral blood flow (CBF) and cerebral blood volume (CBV). Processed, derived perfusion, and T1-weighted images (T1WI), T2WI, and fluid attenuation inversion recovery (FLAIR) MRI sequences were used for segmentation and extraction of tumor perfusion parameters at all time points. Patient, tumor, treatment, and outcome data were summarized and related to perfusion data.
  
  
  RESULTS
  Regional CBF in tumors increased from diagnosis to postradiotherapy, while they decreased to levels below those at diagnosis from postradiotherapy to 6‑month follow-up. At 6 months, the median regional CBF was higher in tumors that progressed (median 1.16) than in those that did not (median, 0.95; P < 0.05). Patients with regional CBF ratios above 1.4 at diagnosis had shorter survival times than did those with regional CBF ratios below 1.4 (P = 0.77). Tumors with a regional CBV above 1.15 at the postradiotherapy (1-3 months) follow-up scan were associated with an earlier time to death than that of tumors with a regional CBV below 1.15 (P < 0.05).
  
  
  CONCLUSIONS
  Posttreatment perfusion characteristics are prognostic and may help predict survival. Overall, perfusion MRI is useful for managing pediatric high-grade glioma and should be incorporated into future clinical trials.
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, 38105-3678, Memphis, TN, USA. john.lucas@stjude.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Lucas
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Knapp
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, 38105-3678, Memphis, TN, USA.
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Uh
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, 38105-3678, Memphis, TN, USA.
authors.forename: Chia-Ho
authors.initials: CH
authors.lastname: Hua
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, 38105-3678, Memphis, TN, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.affiliation: Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Scott N
authors.initials: SN
authors.lastname: Hwang
authors.affiliation: Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Patay
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.|Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D000069347:Erlotinib Hydrochloride
keywords: Conformal radiotherapy; Epidermal growth; High grade glioma; Pediatrics; Perfusion imaging