H. Hawighorst et al., Pharmacokinetic MRI for assessment of malignant glioma response to stereotactic radiotherapy: Initial results, J MAGN R I, 8(4), 1998, pp. 783-788
The purpose of this study was to assess the value of dynamic, contrast-enha
nced MRI in patients with malignant glioma (a) to predict before stereotact
ic radiotherapy local tumor control, (b) to investigate temporal changes in
tumor microcirculation after stereotactic radiotherapy, and (c) to analyze
whether malignant glioma response may be predicted earlier by alterations
in the tissue pharmacokinetics rather than in terms of tumor volume. Ninety
MRI studies were performed of 18 patients with malignant glioma before and
6, 18, 26, 52, and 72 weeks after the end of stereotactic radiotherapy. Th
e signal time courses of the contrast-enhanced tumors were analyzed using a
pharmacokinetic two-compartment model that calculates for the parameter A,
reflecting the degree of MRI signal enhancement [no units] and the exchang
e rate constant k(21) [min(-1)], Before radiotherapy, the amplitude A was s
ignificantly (P <.05) lower in patients with subsequent local tumor control
(n = 8; mean A =.34 +/- .15) compared to patients without subsequent local
tumor control (n = 10; mean A =.94 +/- .71). In the local tumor control gr
oup, early after stereotactic radiotherapy (at 6-18 weeks), there was a sig
nificant (P <.05) time-dependent decrease in the parameter k(21), whereas t
here was still no alteration in the tumor volume. A low amplitude A before
radiotherapy, combined with an early drop of k(21) after stereotactic radio
therapy, reliably characterized the group of patients with subsequent tumor
volume decrease. Our preliminary results suggest that two contrast-enhance
d dynamic MR studies, one before and one early after stereotactic radiother
apy, offer important information on local tumor control within the first 6
to 18 weeks after stereotactic radiotherapy. Moreover, this response may be
evidenced before tumor volume changes and provides a therapeutic window to
broaden treatment options and to improve treatment outcome.