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Early Detection of Response to Radiation Therapy in Patients With Brain Malignancies Using Conventional and High b-Value Diffusion-Weighted Magnetic Resonance Imaging

Yael Mardor, Raphael Pfeffer, Roberto Spiegelmann, Yiftach Roth, Stephan E. Maier, Ouzi Nissim, Raanan Berger, Ami Glicksman, Jacob Baram, Arie Orenstein, Jack S. Cohen, Thomas Tichler

From the Advanced Technology Center, Neurosurgery Department, Oncology Institute, and Plastic Surgery Department, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine and the School of Physics and Astronomy, Tel-Aviv University, Ramat-Aviv, Israel; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Address reprint requests to Yael Mardor, PhD, The Advanced Technology Center, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel; email: yael{at}tauphy.tau.ac.il.

Purpose: To study the feasibility of using diffusion-weighted magnetic resonance imaging (DWMRI), which is sensitive to the diffusion of water molecules in tissues, for detection of early tumor response to radiation therapy; and to evaluate the additional information obtained from high DWMRI, which is more sensitive to low-mobility water molecules (such as intracellular or bound water), in increasing the sensitivity to response.

Patients and Methods: Standard MRI and DWMRI were acquired before and at regular intervals after initiating radiation therapy for 10 malignant brain lesions in eight patients.

Results: One week posttherapy, three of six responding lesions showed an increase in the conventional DWMRI parameters. Another three responding lesions showed no change. Four nonresponding lesions showed a decrease or no change. The early change in the diffusion parameters was enhanced by using high DWMRI. When high DWMRI was used, all responding lesions showed increase in the diffusion parameter and all nonresponding lesions showed no change or decrease. Response was determined by standard MRI 7 weeks posttherapy. The changes in the diffusion parameters measured 1 week after initiating treatment were correlated with later tumor response or no response (P < .006). This correlation was increased to P < .0006 when high DWMRI was used.

Conclusion: The significant correlation between changes in diffusion parameters 1 week after initiating treatment and later tumor response or no response suggests the feasibility of using DWMRI for early, noninvasive prediction of tumor response. The ability to predict response may enable early termination of treatment in nonresponding patients, prevent additional toxicity, and allow for early changes in treatment.

Supported by the Israel Science Foundation, the Israel Cancer Research Fund, Adams Super Center for Brain Studies at Tel-Aviv University, the Izmel program of the Israel Ministry of Industry and Commerce, and National Institutes of Health grant no. R01 NS39335.

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