Purpose To quantify changes and prognostic value of diffusion MRI measurements obtained using mono-exponential, dif- fusion kurtosis imaging (DKI) and stretched exponential (SE) models prior and after chemoradiation in newly diagnosed glioblastoma (GBM). Methods Diffusion-weighted images (DWIs) were acquired in twenty-three patients following surgery, prior chemoradia- tion and within 7 days following completion of treatment, using b-values ranging from 0 to 5000s/mm . Mono-exponential diffusion (apparent diffusion coefficient: ADC), isotropic (non-directional) DKI model with apparent diffusivity (Dapp) and kurtosis (Kapp) estimates as well as SE model with distributed-diffusion coefficient (DDC) and mean intra-voxel het- erogeneity (α) were computed for all patients prior and after chemoradiation. Median values were calculated for normal appearing white matter (NAWM) and contrast-enhancing tumor (CET). The magnitudes of diffusion change prior and after chemoradiation were used to predict overall survival (OS). Results Diffusivity in NAWM was consistent for all diffusion measures during chemoradiation, while diffusivity measure- ments (ADC, Dapp and DDC) within CET changed significantly. A strong positive correlation existed between ADC, Dapp, and DDC measurements prior to chemoradiation; however, this association was weak following chemoradiation, suggest- ing a more complex microstructural environment after cytotoxic therapy. When combined with baseline tumor volume and MGMT status, age
Journal of Neuro-Oncology – Springer Journals
Published: May 31, 2018
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