Journal
AMERICAN JOURNAL OF NEURORADIOLOGY
Volume 33, Issue 9, Pages 1763-1770Publisher
AMER SOC NEURORADIOLOGY
DOI: 10.3174/ajnr.A3053
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Funding
- Genentech Inc
- Genentech/Roche
- Roche
- Genentech
- Merck
- UCLA Institute for Molecular Medicine Seed Grant
- UCLA Radiology Exploratory Research Grant
- Brain Tumor Funders Collaborative
- Art of the Brain
- Ziering Family Foundation in memory of Sigi Ziering
- Singleton Family Foundation
- Clarence Klein Fund for Neuro-Oncology
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BACKGROUND AND PURPOSE: A subset of patients with malignant glioma develops conspicuous lesions characterized by persistent restricted diffusion during treatment with bevacizumab. The purpose of the current study was to characterize the evolution of these lesions and to determine their relationship to patient outcome. MATERIALS AND METHODS: Twenty patients with malignant glioma with persistent restricted-diffusion lesions undergoing treatment with bevacizurnab were included in the current study. Mean ADC and the volume of restricted diffusion were computed for each patient during serial follow-up. Differences in UP, US, and OS were compared between patients with restricted diffusion and matched controls by using Kaplan-Meier analysis with the logrank test and Cox hazard models. RESULTS: Mean ADC values were generally stable with time (mean, 5.2 +/- 12.6% change from baseline). The volume of restricted diffusion increased a median of 23% from baseline by 6 months. Patients with restricted-diffusion lesions had significantly greater UP (logrank, P = .013), TTS (logrank, P = .008), and OS (logrank, P = .010) than matched controls. When available, advanced physiologic imaging of restricted-diffusion lesions showed hypovascularity on perfusion MR imaging and decreased amino acid uptake on F-18-FDOPA PET scans. Atypical gelat nous necrotic tissue was confirmed in the area of restricted diffusion in 1 patient. CONCLUSIONS: Restricted-diffusion lesions in malignant gliomas treated with bevacizumab are generally stable with time and are associated with improved outcomes These results combined with physiologic imaging and histopathologic data suggest that these lesions are not consistent with aggressive tumor.
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