AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on February 13, 2008
doi: 10.3174/ajnr.A0963
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Brain Tumor Imaging in Clinical Trials

J.W. Hensona,b,c,d,e,f, S. Ulmera and G.J. Harrisc,d,f

a Stephen E. and Catherine Pappas Brain Tumor Imaging Research Program, Massachusetts General Hospital, Boston, Mass
b Division of Neuroradiology, Massachusetts General Hospital, Boston, Mass
c 3D Imaging Service, Massachusetts General Hospital, Boston, Mass
d Department of Radiology, Massachusetts General Hospital, Boston, Mass
e Neurology Service, Massachusetts General Hospital, Boston, Mass
f Harvard Medical School, Boston, Mass


Figure 1
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  		Fig 1. Three enhancing foci in a patient with glioblastoma illustrate issues with lesion measurement during clinical trials. Lesion A is homogeneously enhancing and exceeds 10 mm in diameter and thus is ideal for serial measurement by RECIST or 1D (lower left), Macdonald or 2D (lower right), and volumetric (upper right) approaches. Lesion B is predominantly necrotic and is amenable to volumetric measurement (upper right) because the enhancing and nonenhancing components can be segmented. Lesion C is too small in diameter (8 mm) for accurate serial measurement and should be followed as a nonmeasurable lesion (see text). Images are postgadolinium contrast-enhanced axial T1-weighted.


Figure 2
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  		Fig 2. Infarcts on immediate postoperative MR images are common. These infarcts often demonstrate nodular gadolinium enhancement on subsequent studies, a finding that could be easily confused with tumor. Immediate postoperative DWI (upper left) and apparent diffusion coefficient (upper right) show restricted diffusion (arrows), followed by a 3-month postoperative T2-weighted (lower left) image and a gadolinium-enhanced T1-weighted (lower right) image showing encephalomalacia and enhancement of the infarct. (Reprinted by permission of Lippincott Williams & Wilkins; Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology 2006;67:1668–70).


Figure 3
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  		Fig 3. Novel therapeutic agents in clinical trials may require use of imaging techniques other than gadolinium-enhancing tumor. Shown here is decreased tumor enhancement but not diameter in a patient with glioblastoma after initiation of a therapy with an inhibitor of VEGF and irinotecan. Note the increase in extent of the infiltrative component of the lesion (lower right). Axial post-gadolinium contrast T1-weighted images (left-hand column) and axial T2-weighted/fluid-attenuated inversion recovery images (right-hand column) were acquired before (upper row) and 7 weeks after (lower row) institution of therapy.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X