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PURPOSE: After standard treatment for glioblastoma, perfusion MRI remains challenging for differentiating tumor progression from post-treatment changes. Our objectives were (1) to correlate rCBV values at diagnosis and at first tumor progression and (2) to analyze the relationship of rCBV values at tumor recurrence with enhancing volume, localization of tumor progression, and time elapsed since the end of radiotherapy in tumor recurrence. METHODS: Inclusion criteria were (1) age > 18 years, (2) histologically confirmed glioblastoma treated with STUPP regimen, and (3) tumor progression according to RANO criteria > 12 weeks after radiotherapy. Co-registration of segmented enhancing tumor VOIs with dynamic susceptibility contrast perfusion MRI was performed using Olea Sphere software. For tumor recurrence, we correlated rCBV values with enhancing tumor volume, with recurrence localization, and with time elapsed from the end of radiotherapy to progression. Analyses were performed with SPSS software. RESULTS: Sixty-four patients with glioblastoma were included in the study. Changes in rCBV values between diagnosis and first tumor progression were significant (p < 0.001), with a mean and median decreases of 32% and 46%, respectively. Mean rCBV values were also different (p < 0.01) when tumors progressed distally (radiation field rCBV values of 1.679 versus 3.409 distally). However, changes and, therefore, low rCBV values after radiotherapy in tumor recurrence were independent of time. CONCLUSION: Chemoradiation alters tumor perfusion and rCBV values may be decreased in the setting of tumor progression. Changes in rCBV values with respect to diagnosis, with low rCBV in tumor progression, are independent of time but related to the site of recurrence.
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Neoplasias Encefálicas , Glioblastoma , Humanos , Adulto , Persona de Mediana Edad , Glioblastoma/diagnóstico por imagen , Glioblastoma/radioterapia , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Recurrencia Local de Neoplasia/diagnóstico por imagen , Medios de Contraste , Quimioradioterapia , Imagen por Resonancia Magnética/métodosRESUMEN
BACKGROUND: The apparent diffusion coefficient (ADC) in MRI seems to be related to cellularity in brain tumours. Its utility as a tool for distinguishing between histological types and tumour stages remains controversial. PROCEDURES: We retrospectively evaluated children diagnosed with CNS tumours between January 2008 and December 2013. Data collected were age, sex, histological diagnosis, and location of the tumour. We evaluated the ADC and ADC ratio and correlated those values with histological diagnoses. RESULTS: The study included 55 patients with a median age of 6 years. Histological diagnoses were pilocytic astrocytoma (40%), anaplastic ependymoma (16.4%), ganglioglioma (10.9%), glioblastoma (7.3%), medulloblastoma (5.5%), and other (20%). Tumours could also be classified as low-grade (64%) or high-grade (36%). Mean ADC was 1.3 for low-grade tumours and 0.9 for high-grade tumours (p=.004). Mean ADC ratios were 1.5 and 1.2 for low and high-grade tumours respectively (p=.025). There were no significant differences in ADC/ADC ratio between different histological types. CONCLUSION: ADC and ADC ratio may be useful in imaging-study based differential diagnosis of low and high-grade tumours, but they are not a substitute for an anatomical pathology study.
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Neoplasias Encefálicas/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/estadística & datos numéricos , Adolescente , Niño , Preescolar , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Lactante , Masculino , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
INTRODUCTION: Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to ß-amyloid deposition in the walls of cerebral microvessels. METHODS: We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS: The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (nâ¯=â¯6), behavioural alterations (nâ¯=â¯5), epileptic seizures (nâ¯=â¯5), focal neurological signs (nâ¯=â¯4), and headache (nâ¯=â¯2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (nâ¯=â¯7), subcortical white matter hyperintensities on T2-FLAIR sequences (nâ¯=â¯7), and leptomeningeal enhancement (nâ¯=â¯6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (nâ¯=â¯5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS: Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Angiopatía Amiloide Cerebral , Masculino , Humanos , Anciano , Angiopatía Amiloide Cerebral/complicaciones , Angiopatía Amiloide Cerebral/diagnóstico por imagen , Inflamación/patología , Imagen por Resonancia Magnética , Radiografía , Estudios RetrospectivosRESUMEN
INTRODUCTION: Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to ß-amyloid deposition in the walls of cerebral microvessels. METHODS: We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS: The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS: Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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BACKGROUND: Some phase 2 trials had reported encouraging progression-free survival with Bevacizumab in monotherapy or combined with chemotherapy in glioblastoma. However, phase 3 trials showed a significant improvement in progression free survival without a benefit in overall survival. To date, there are no predictive biomarker of response for Bevacizumab in glioblastoma. METHODS: We used Immunochemical analysis on tumor samples and pretreatment and post-treatment perfusion-MRI to try to identify possible predictive angiogenesis-related biomarkers of response and survival in patients with glioblastoma treated with bevacizumab in the first recurrence. We analyzed histological parameters: vascular proliferation, mitotic number and Ki-67 index; molecular factors: MGMT promoter methylation, EGFR amplification and EGFR variant III; immunohistochemical: MET, Midkine, HIF1, VEGFA, VEGF-R2, CD44, Olig2, microvascular area and microvascular density; and radiological: rCBV. RESULTS: In the statistical analysis, no significant correlation of any histological, molecular, microvascular or radiological parameters could be demonstrated with the response rate, PFS or OS with bevacizumab treatment. CONCLUSION: Unfortunately, in this histopathological, molecular, immunohistochemical and neuroradiological study we did not find any predictive biomarker of response or survival benefit for Bevacizumab in glioblastoma.
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Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Bevacizumab/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Glioblastoma/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Adulto , Anciano , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/química , Neoplasias Encefálicas/diagnóstico por imagen , Circulación Cerebrovascular , Metilasas de Modificación del ADN/metabolismo , Enzimas Reparadoras del ADN/metabolismo , Femenino , Amplificación de Genes , Genes erbB-1 , Glioblastoma/irrigación sanguínea , Glioblastoma/química , Glioblastoma/diagnóstico por imagen , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Masculino , Metilación , Microvasos/patología , Persona de Mediana Edad , Índice Mitótico , Recurrencia Local de Neoplasia/irrigación sanguínea , Recurrencia Local de Neoplasia/química , Recurrencia Local de Neoplasia/diagnóstico por imagen , Estudios Retrospectivos , Análisis de Matrices Tisulares , Proteínas Supresoras de Tumor/metabolismoRESUMEN
Introducción: El coeficiente de difusión aparente (ADC) de la resonancia magnética parece relacionarse con el grado de celularidad de los tumores de sistema nervioso central. Su utilidad para diferenciar el grado tumoral y tipo histológico de los tumores es controvertido. Material y métodos: Estudio retrospectivo de los pacientes pediátricos con diagnóstico de tumor de sistema nervioso central desde enero-2008 a diciembre-2013. Se revisan edad, sexo, localización del tumor y anatomía patológica. Las medidas de ADC y ratio ADC (cociente ADC tumoral/ADC tejido sano) se llevaron a cabo por 2 neurorradiólogos expertos, ciegos al diagnóstico histológico. Se calcula el valor ADC y el ratio ADC y se comparan sus valores con los diagnósticos anatomopatológicos. Resultados: Se incluyen 55 pacientes. La mediana de edad fue 6 años. Los diagnósticos anatomopatológicos fueron: astrocitoma pilocítico (40%), ependimoma anaplásico (16,4%), ganglioglioma (10,9%), glioblastoma (7,3%), meduloblastoma (5,5%), y otros (20%). El 64% fueron de bajo grado (BG) y el 36% de alto grado (AG). La media de ADC fue 1,3 en los de BG y 0,9 en los de AG (p = 0,004). La media de ratio ADC fue de 1,5 y 1,2 (p = 0,025) respectivamente. No hubo diferencias significativas en el ADC/ratio ADC entre los distintos tipos histológicos. Conclusiones: El ADC y ratio ADC son una herramienta útil en la diferenciación por imagen del grado tumoral en los tumores cerebrales pediátricos, sin sustituir a la anatomía patológica
Background: The apparent diffusion coefficient (ADC) in MRI seems to be related to cellularity in brain tumours. Its utility as a tool for distinguishing between histological types and tumour stages remains controversial. Procedures: We retrospectively evaluated children diagnosed with CNS tumours between January 2008 and December 2013. Data collected were age, sex, histological diagnosis, and location of the tumour. We evaluated the ADC and ADC ratio and correlated those values with histological diagnoses. Results: The study included 55 patients with a median age of 6 years. Histological diagnoses were pilocytic astrocytoma (40%), anaplastic ependymoma (16.4%), ganglioglioma (10.9%), glioblastoma (7.3%), medulloblastoma (5.5%), and other (20%). Tumours could also be classified as low-grade (64%) or high-grade (36%). Mean ADC was 1.3 for low-grade tumours and 0.9 for high-grade tumours (p = .004). Mean ADC ratios were 1.5 and 1.2 for low and high-grade tumours respectively (p = .025). There were no significant differences in ADC/ADC ratio between different histological types. Conclusion: ADC and ADC ratio may be useful in imaging-study based differential diagnosis of low and high-grade tumours, but they are not a substitute for an anatomical pathology study