Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma
Purpose: Diffusion tensor imaging for evaluation of white matter tracts is used with magnetic resonance spectroscopy (MRS) to improve management of diffuse intrinsic pontine glioma (DIPG). Changes in the apparent diffusion coefficient (ADC), fractional anisotropy (FA), and tumor metabolite ratios ha...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109421002050 |
| _version_ | 1818286038066397184 |
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| author | Julianna K. Bronk, MD, PhD Ping Hou, PhD Mark J. Amsbaugh, MD Soumen Khatua, MD Anita Mahajan, MD Leena Ketonen, MD Susan L. McGovern, MD, PhD |
| author_facet | Julianna K. Bronk, MD, PhD Ping Hou, PhD Mark J. Amsbaugh, MD Soumen Khatua, MD Anita Mahajan, MD Leena Ketonen, MD Susan L. McGovern, MD, PhD |
| author_sort | Julianna K. Bronk, MD, PhD |
| collection | DOAJ |
| description | Purpose: Diffusion tensor imaging for evaluation of white matter tracts is used with magnetic resonance spectroscopy (MRS) to improve management of diffuse intrinsic pontine glioma (DIPG). Changes in the apparent diffusion coefficient (ADC), fractional anisotropy (FA), and tumor metabolite ratios have been reported after initial radiation for DIPG, but these markers have not been studied sequentially in patients undergoing reirradiation for progressive DIPG. Here, we report a case series of 4 patients who received reirradiation for progressive DIPG on a prospective clinical trial in which we evaluated quantitative changes in FA, ADC, and tumor metabolites and qualitative changes in white matter tracts. Methods and Materials: The median reirradiation dose was 25.2 Gy (24-30.8 Gy). Fiber tracking was performed using standard tractography analysis. The FA and ADC values for the corticospinal and medial lemniscus tracts were calculated before and after reirradiation. Multivoxel MRS was performed. Findings were correlated with clinical features and conventional MRI of tumors. Results: All patients had an initial response to reirradiation as shown by a decrease in tumor size. In general, FA increased with disease response and decreased with progression, whereas ADC decreased with disease response and increased with progression. At second progression, the FA fold change relative to values during disease response decreased in both patients with available imaging at second progression. Visualization of tracts demonstrated robust reconstitution of previously disrupted paths during tumor response; conversely, there was increased fiber tract disruption and infiltration during tumor progression. The MRS analysis revealed a decrease in choline:creatinine and choline:N-acetylaspartate ratios during tumor response and increase during progression. Conclusions: Distinct changes in white matter tracts and tumor metabolism were observed in patients with DIPG undergoing reirradiation on a prospective clinical trial. Changes related to tumor response and progression were observed after 24 to 30.8 Gy reirradiation. |
| first_indexed | 2024-12-13T01:18:14Z |
| format | Article |
| id | doaj.art-407e22a1b619418aa23f0e2547a7ec63 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-13T01:18:14Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-407e22a1b619418aa23f0e2547a7ec632022-12-22T00:04:17ZengElsevierAdvances in Radiation Oncology2452-10942022-03-0172100847Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine GliomaJulianna K. Bronk, MD, PhD0Ping Hou, PhD1Mark J. Amsbaugh, MD2Soumen Khatua, MD3Anita Mahajan, MD4Leena Ketonen, MD5Susan L. McGovern, MD, PhD6Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartments of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, Mayo Clinic, Rochester, MinnesotaDepartments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TexasDepartments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Corresponding author: Susan L. McGovern, MD, PhDPurpose: Diffusion tensor imaging for evaluation of white matter tracts is used with magnetic resonance spectroscopy (MRS) to improve management of diffuse intrinsic pontine glioma (DIPG). Changes in the apparent diffusion coefficient (ADC), fractional anisotropy (FA), and tumor metabolite ratios have been reported after initial radiation for DIPG, but these markers have not been studied sequentially in patients undergoing reirradiation for progressive DIPG. Here, we report a case series of 4 patients who received reirradiation for progressive DIPG on a prospective clinical trial in which we evaluated quantitative changes in FA, ADC, and tumor metabolites and qualitative changes in white matter tracts. Methods and Materials: The median reirradiation dose was 25.2 Gy (24-30.8 Gy). Fiber tracking was performed using standard tractography analysis. The FA and ADC values for the corticospinal and medial lemniscus tracts were calculated before and after reirradiation. Multivoxel MRS was performed. Findings were correlated with clinical features and conventional MRI of tumors. Results: All patients had an initial response to reirradiation as shown by a decrease in tumor size. In general, FA increased with disease response and decreased with progression, whereas ADC decreased with disease response and increased with progression. At second progression, the FA fold change relative to values during disease response decreased in both patients with available imaging at second progression. Visualization of tracts demonstrated robust reconstitution of previously disrupted paths during tumor response; conversely, there was increased fiber tract disruption and infiltration during tumor progression. The MRS analysis revealed a decrease in choline:creatinine and choline:N-acetylaspartate ratios during tumor response and increase during progression. Conclusions: Distinct changes in white matter tracts and tumor metabolism were observed in patients with DIPG undergoing reirradiation on a prospective clinical trial. Changes related to tumor response and progression were observed after 24 to 30.8 Gy reirradiation.http://www.sciencedirect.com/science/article/pii/S2452109421002050 |
| spellingShingle | Julianna K. Bronk, MD, PhD Ping Hou, PhD Mark J. Amsbaugh, MD Soumen Khatua, MD Anita Mahajan, MD Leena Ketonen, MD Susan L. McGovern, MD, PhD Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma Advances in Radiation Oncology |
| title | Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma |
| title_full | Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma |
| title_fullStr | Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma |
| title_full_unstemmed | Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma |
| title_short | Sequential Diffusion Tensor Imaging and Magnetic Resonance Spectroscopy in Patients Undergoing Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma |
| title_sort | sequential diffusion tensor imaging and magnetic resonance spectroscopy in patients undergoing reirradiation for progressive diffuse intrinsic pontine glioma |
| url | http://www.sciencedirect.com/science/article/pii/S2452109421002050 |
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