Download ppt - Diffusion MRI is sensitive to brain tumor cell density Clinical ADC and cell density are negatively correlated (Sugahara, 1999; Lyng, 2000; Chenevert,

Diffusion MRI is sensitive to brain tumor cell density

Clinical ADC and cell density are negatively correlated

(Sugahara, 1999; Lyng, 2000; Chenevert, 2000; Gaurain, 2001; Nonomura, 2001; Guo, 2002; Chen, 2005; Hayashida, 2006; Manenti, 2008; Kinoshita, 2008)

ADC (or mean diffusion) = cell density (“hypercellularity”)ADC = cell density (“hypocellularity”)

Viable Tumor (Dark)

Necrotic Core

Edema

ADC Map

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010

Diffusion MRI is sensitive to brain tumor cell density

Tests at our laboratory have confirmed this relationship

- 17 glioma patients (WHO II-IV) underwent diagnostic stereotactic biopsy- Biopsy sites were spatially matched to pre-operative ADC maps

R2 = 0.7933; P < 0.001

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009From: Ellingson, et al. JMRI 2009, In Press

The Functional Diffusion Map (fDM)(Moffat, 2005; 2006; Hamstra, 2005; 2008)

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 From: Ellingson, JMRI, 2009, In Press

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2009 SNO/CNS 2009B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2009 SNO/CNS 2009B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 From: Ellingson et al. J Neurooncol, 2009, In Press

Early Detection of Brain Tumor Growth

T1+C

FLAIR

fDMs


HypercellularRegions (Blue)

Contrast-Enhancement(white)

fDMs in Brain Tumor Progression


T1+C

FLAIR

fDM

3 mo. 6 mo. 9 mo. (Onset of symptoms)

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009

fDMs in Progressive Disease (PD)

Hypercellularity

Hypercellularity

Hypercellularity

fDM Results in Stable Disease (SD)

Treatment: Radiation + Temozolomide


Treatment: Radiation + Temozolomide

fDM Results in Responding Disease (RD)


fDM Results in Stable/Responding Disease (SD/RD)


Hypocellularity Hypocellularity

Hypocellularity

fDMs are an early biomarker for cytotoxic and new anti-angiogenic treatments

B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 Ellingson BM, J Neurooncol, Under Prep

Results


• “fDM Responders” have significantly longer TTP after standard Tx– fDMs are a better predictor than tumor grade

Results


• “fDM Responders” have significantly longer survival on bevacizumab– fDMs are better predictors than grade, age, or mono/combined therapy

Graded fDMs Allow Visualization of Growing Tumor


+ Hypercellular+ Hypocellular

1 Mo. 2 Mo. 3 Mo. 4 Mo.




7 Mo.5 Mo.3 Mo.




5 Mo.4 Mo.2 Mo.

Hyp

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Hyp

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Macrophages& Inflammatory Cells

Demyelination

Graded fDMs in Demyelination


Biopsy Diagnosis = Demyelination (Multiple Sclerosis)

3 Mo. 5 Mo. 7 Mo. 9 Mo.

Graded fDMs: Radiation Necrosis vs. Tumor


Hyp

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Hyp

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T1+

CF

LAIR

Gra

ded

fDM

Graded fDMs: Radiation Induced Changes


Hyp

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Hyp

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2 Mo. 3 Mo. 5 Mo. 8 Mo.

14 Mo. 18 Mo. 21 Mo. 23 Mo.

Graded fDMs: Radiation Induced Changes


Hyp

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Hyp

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2 Mo. 4 Mo. 6 Mo.

10 Mo. 14 Mo.18 Mo.

Graded fDMs Improve Tumor Localization/Grading in Stereotactic Needle Biopsy


Graded fDMs Improve Tumor Localizationand Grading in Stereotactic Needle Biopsy


2 LesionsBiopsy (WHO II)

Hyp

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Hyp

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Graded fDMs Improve Tumor Localization for Resection


Hyp

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ResectionCavity

Only 10% of Hypercellularregions were removed!