Skip to main content

Advertisement

SpringerLink
Log in

Combining diffusion and perfusion differentiates tumor from bevacizumab-related imaging abnormality (bria)

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

A subset of patients with high-grade glioma and brain metastases who are treated with bevacizumab develop regions of marked and persistent restricted diffusion that do not reflect recurrent tumor. Here, we quantify the degree of restricted diffusion and the relative cerebral blood volume (rCBV) within these regions of bevacizumab-related imaging abnormality (BRIA) in order to facilitate differentiation of these lesions from recurrent tumor. Six patients with high-grade glioma and two patients with brain metastases who developed regions of restricted diffusion after initiation of bevacizumab were included. Six pre-treatment GBM controls were also included. Restriction spectrum imaging (RSI) was used to create diffusion maps which were co-registered with rCBV maps. Within regions of restricted diffusion, mean RSI values and mean rCBV values were calculated for patients with BRIA and for the GBM controls. These values were also calculated for normal-appearing white matter (NAWM). RSI values in regions of restricted diffusion were higher for both BRIA and tumor when compared to NAWM; furthermore RSI values in BRIA were slightly higher than in tumor. Conversely, rCBV values were very low in BRIA—lower than both tumor and NAWM. However, there was only a trend for rCBV values to be higher in tumor than in NAWM. When evaluating areas of restricted diffusion in patients with high-grade glioma or brain metastases treated with bevacizumab, RSI is better able to detect the presence of pathology whereas rCBV is better able to differentiate BRIA from tumor. Thus, combining these tools may help to differentiate necrotic tissue related to bevacizumab treatment from recurrent tumor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

BRIA:

Bevacizumab-related imaging abnormality

GBM:

Glioblastoma multiforme

NAWM:

Normal-appearing white matter

NSCLC:

Non-small cell lung cancer

rCBV:

Relative cerebral blood volume

RSI:

Restriction spectrum imaging

VEGF:

Vascular endothelial growth factor

References

  1. Friedman HS, Prados MD, Wen PY et al (2009) Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol 27:4733–4740

    Article  CAS  PubMed  Google Scholar 

  2. Soffietti R, Trevisan E, Ruda R (2012) Targeted therapy in brain metastasis. Curr Opin Oncol 24:679–686

    Article  CAS  PubMed  Google Scholar 

  3. Schettino C, Bareschino MA, Rossi A et al (2012) Targeting angiogenesis for treatment of NSCLC brain metastases. Curr Cancer Drug Targets 12:289–299

    Article  CAS  PubMed  Google Scholar 

  4. Hygino da Cruz LC Jr, Rodriguez I, Domingues RC et al (2011) Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. Am J Neuroradiol (AJNR) 32:1978–1985

    Article  Google Scholar 

  5. Jeyaretna DS, Curry WT Jr, Batchelor TT et al (2011) Exacerbation of cerebral radiation necrosis by bevacizumab. J Clin Oncol 29:e159–e162

    Article  PubMed  Google Scholar 

  6. Mong S, Ellingson BM, Nghiemphu PL et al (2012) Persistent diffusion-restricted lesions in bevacizumab-treated malignant gliomas are associated with improved survival compared with matched controls. Am J Neuroradiol (AJNR) 33:1763–1770

    Article  CAS  Google Scholar 

  7. Rieger J, Bahr O, Muller K et al (2010) Bevacizumab-induced diffusion-restricted lesions in malignant glioma patients. J Neurooncol 99:49–56

    Article  CAS  PubMed  Google Scholar 

  8. Kono K, Inoue Y, Nakayama K et al (2001) The role of diffusion-weighted imaging in patients with brain tumors. Am J Neuroradiol (AJNR) 22:1081–1088

    CAS  Google Scholar 

  9. Sugahara T, Korogi Y, Kochi M et al (1999) Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 9:53–60

    Article  CAS  PubMed  Google Scholar 

  10. White NS, Leergaard TB, D’Arceuil H et al (2013) Probing tissue microstructure with restriction spectrum imaging: histological and theoretical validation. Hum Brain Mapp 34:327–346

    Article  PubMed Central  PubMed  Google Scholar 

  11. White NS, McDonald CR, Farid N et al (2013) Improved conspicuity and delineation of primary and metastatic brain tumors using “restriction spectrum imaging”: quantitative comparison with high b-value DWI and ADC. Am J Neuroradiol (AJNR) 34:958–964

    Article  CAS  Google Scholar 

  12. Kothari PD, White NS, Farid N et al (2013) Longitudinal restriction spectrum imaging is resistant to pseudoresponse in patients with high-grade gliomas treated with bevacizumab. Am J Neuroradiol (AJNR) 34:1752–1757

    Article  CAS  Google Scholar 

  13. Holland D, Kuperman JM, Dale AM (2010) Efficient correction of inhomogeneous static magnetic field-induced distortion in echo planar imaging. Neuroimage 50:175–183

    Article  PubMed Central  PubMed  Google Scholar 

  14. Emblem KE, Bjornerud A (2009) An automatic procedure for normalization of cerebral blood volume maps in dynamic susceptibility contrast-based glioma imaging. Am J Neuroradiol (AJNR) 30:1929–1932

    Article  CAS  Google Scholar 

  15. Boothe D, Young R, Yamada Y et al (2013) Bevacizumab as a treatment for radiation necrosis of brain metastases post stereotactic radiosurgery. Neuro Oncol 15:1257–1263

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Sadraei NH, Dahiya S, Chao ST et al (2013) Treatment of cerebral radiation necrosis with bevacizumab: the Cleveland clinic experience. Am J Clin Oncol 90(3):192–200

    Google Scholar 

  17. Ellingson BM, Malkin MG, Rand SD et al (2010) Validation of functional diffusion maps (fDMs) as a biomarker for human glioma cellularity. J Magn Reson Imaging 31:538–548

    Article  PubMed Central  PubMed  Google Scholar 

  18. Shah R, Vattoth S, Jacob R et al (2012) Radiation necrosis in the brain: imaging features and differentiation from tumor recurrence. Radiographics 32:1343–1359

    Article  PubMed  Google Scholar 

  19. Yoshii Y (2008) Pathological review of late cerebral radionecrosis. Brain Tumor Pathol 25:51–58

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding: NIH Grants R01NS065838 (C.R.M.), RC2 DA29475 (A.M.D.) and EB00790-06 (A.M.D.) and 3P30CA023100-25S8 (S.K.), CAPES for PhD student scholarship (D.B.A.F).

Conflict of interest

None of the authors have any personal or institutional financial interest in drugs, materials, or devices described in this submission.

Author information

Authors and Affiliations

  1. Department of Radiology, University of California, San Diego, 200 West Arbor Drive, MC 0834, San Diego, CA, 92103-0834, USA

    Nikdokht Farid, Daniela B. Almeida-Freitas, Nathan S. White, Joshua M. Kuperman, Abdulrahman A. Almutairi & Anders M. Dale

  2. Department of Radiology, University of São Paulo, Largo São Francisco, 95-Centro, São Paulo, 01005-010, Brazil

    Daniela B. Almeida-Freitas

  3. Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0603, La Jolla, CA, 92093-0603, USA

    Carrie R. McDonald & Anders M. Dale

  4. Department of Pathology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Karra A. Muller & Scott R. VandenBerg

  5. Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0662, USA

    Santosh Kesari & Anders M. Dale

  6. Multimodal Imaging Laboratory, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA

    Nikdokht Farid, Daniela B. Almeida-Freitas, Nathan S. White, Carrie R. McDonald, Joshua M. Kuperman, Abdulrahman A. Almutairi & Anders M. Dale

  7. Translational Neuro-Oncology Laboratories, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA

    Santosh Kesari

  8. Department of Radiology, University of California, San Diego, 200 West Arbor Drive #8756;, San Diego, CA, 92103, USA

    Nikdokht Farid

Authors
  1. Nikdokht Farid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniela B. Almeida-Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathan S. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carrie R. McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua M. Kuperman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abdulrahman A. Almutairi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karra A. Muller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott R. VandenBerg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Santosh Kesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anders M. Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikdokht Farid.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farid, N., Almeida-Freitas, D.B., White, N.S. et al. Combining diffusion and perfusion differentiates tumor from bevacizumab-related imaging abnormality (bria). J Neurooncol 120, 539–546 (2014). https://doi.org/10.1007/s11060-014-1583-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-014-1583-2

Keywords

Search

Navigation