RT Journal Article
SR Electronic
T1 A Novel Methodology for Applying Multivoxel MR Spectroscopy to Evaluate Convection-Enhanced Drug Delivery in Diffuse Intrinsic Pontine Gliomas
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1367
OP 1373
DO 10.3174/ajnr.A4713
VO 37
IS 7
A1 D.I. Guisado
A1 R. Singh
A1 S. Minkowitz
A1 Z. Zhou
A1 S. Haque
A1 K.K. Peck
A1 R.J. Young
A1 A.J. Tsiouris
A1 M.M. Souweidane
A1 S.B. Thakur
YR 2016
UL http://www.ajnr.org/content/37/7/1367.abstract
AB BACKGROUND AND PURPOSE: Diffuse intrinsic pontine gliomas are inoperable high-grade gliomas with a median survival of less than 1 year. Convection-enhanced delivery is a promising local drug-delivery technique that can bypass the BBB in diffuse intrinsic pontine glioma treatment. Evaluating tumor response is critical in the assessment of convection-enhanced delivery of treatment. We proposed to determine the potential of 3D multivoxel 1H-MR spectroscopy to evaluate convection-enhanced delivery treatment effect in these tumors.MATERIALS AND METHODS: We prospectively analyzed 3D multivoxel 1H-MR spectroscopy data for 6 patients with nonprogressive diffuse intrinsic pontine gliomas who received convection-enhanced delivery treatment of a therapeutic antibody (Phase I clinical trial NCT01502917). To compare changes in the metabolite ratios with time, we tracked the metabolite ratios Cho/Cr and Cho/NAA at several ROIs: normal white matter, tumor within the convection-enhanced delivery infusion site, tumor outside of the infused area, and the tumor average.RESULTS: There was a comparative decrease in both Cho/Cr and Cho/NAA metabolite ratios at the tumor convection-enhanced delivery site versus tumor outside the infused area. We used MR spectroscopy voxels with dominant white matter as a reference. The difference between changes in metabolite ratios became more prominent with increasing time after convection-enhanced delivery treatment.CONCLUSIONS: The comparative change in metabolite ratios between the convection-enhanced delivery site and the tumor site outside the infused area suggests that multivoxel 1H-MR spectroscopy, in combination with other imaging modalities, may provide a clinical tool to accurately evaluate local tumor response after convection-enhanced delivery treatment.CEDconvection-enhanced deliveryDIPGdiffuse intrinsic pontine gliomaMRSIMR spectroscopic imagingpreCED1 week prior to CED treatmentpostCED11 day after CED treatmentpostCED21 month after CED treatmentpostCED32 months after CED treatment