Article Figures & Data
Figures
- Fig 1.
Representative example of voxel placement onto registered grid overlay on the pre-SIACI (A) and post-SIACI (B) of bevacizumab T2-weighted FLAIR MRS localizer images demonstrating the 5 aforementioned regions of interest selected for analysis: red = enhancing component; orange = nonenhancing T2-hyperintense signal abnormality; green = matched contralateral “normal” parenchyma (corresponding to cumulative area of enhancing and nonenhancing voxels); blue = normal contralateral white matter; purple = normal cortex. ROIs were selected on the pretreatment T2-weighted FLAIR MRS (A) and these 5 identical anatomic areas were then carried over and plotted on the posttreatment T2-weighted FLAIR MRS (B).
- Fig 2.
Two examples (study patients 14 and 16) of MR imaging changes before and after treatment, clearly demonstrating the marked decrease in enhancement associated with a mild decrease in T2 signal abnormality related to bevacizumab therapy. For each patient, images on the left are representative of pre-SIACI bevacizumab scans, and images on the right are matched representative post-SIACI bevacizumab scans. The arrows on the postgadolinium posttreatment T1WI point to the marked decrease in enhancement after SIACI of bevacizumab. Arrows on the posttherapy T2WI FLAIR images demonstrate a significant but less dramatic decrease in abnormal T2 signal. Patient 14 received 15 mg/kg of SIACI of bevacizumab (½ left MCA, ¼ right A1 ACA, ¼ left A1 ACA). Patient 16 similarly received 15 mg/kg of SIACI of bevacizumab (½ right P1 PCA and ½ right M1 MCA).
- Fig 3.
1H-MR spectra for a voxel in a GB in the splenium of the corpus callosum before (A) and after (B) SIACI of bevacizumab, demonstrating reduction of the tCho/NAA ratio posttreatment.
Tables
Pulse Sequence Scan Parameters T1WI 3-plane localizer Sagittal T1WI, FSE TR/TE: 600 ms/minimum; FOV: 250 mm; 352 × 256; ST/gap: 5/0 mm; NEX: 1; ETL: 2; full echo Axial T1WI, FSE TR/TE: 425/20 ms; FOV: 220 mm; 352 × 224; ST/gap: 5 mm/0; NEX: 1; ETL: 2; full echo Axial T2WI FLAIR TR/TE: 9600/140 ms; FOV: 220 mm; 352 × 224; ST/gap: 5 mm/0; NEX: 1; full echo Axial GRE TR/TE: 635 ms/minimum; FOV: 220 mm; 320 × 224; ST/gap: 5 mm/0; NEX: 1; flip angle: 20o; full echo Axial DWI, EPI TR/TE: 8200 ms/minimum; FOV: 220 mm; 128 × 128; ST/gap: 5 mm/0; NEX: 1; no. of shots: 1; full echo Axial T2WI FSE TR/TE: 3167/85 ms; FOV: 220 mm; 416 × 256; ST/gap: 5 mm/0; NEX: 2; ETL: 23 Axial T1WI FSE, postcontrast TR/TE: 425/20 ms; FOV: 220 mm; 352 × 224; ST/gap: 5 mm/0; NEX: 1; ETL: 2; full echo Sagittal 3D spoiled GRE (BRAVO), postcontrast TR/TE/TI: 450 ms/minimum/450 ms; FOV: 307 mm; 256 × 256 × 136; ST: 1.2 mm; NEX: 1; flip angle: 15o Dynamic contrast-enhanced perfusion MRI, gradient-echo EPI TR/TE: 2000 ms/minimum; FOV: 240 mm; 129 × 96; ST/gap: 5 mm/0; NEX: 1; no. of shots: 1; flip angle: 60o Axial multisection 1H-MRS TR/TE: 2300/280 ms; FOV: 240 mm; 20 × 20; ST/gap: 15/3.5 mm; NEX: 1; 4 sections, interleaved. -
Note:—ETL indicates echo-train length; GRE, gradient-recalled echo; ST, section thickness.
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Patient Median % Change tCho/NAA Enhancing Median % Change tCho/NAA Nonenhancing Median % Change tCho/NAA Control Median % Change tCho/NAA White Matter Median % Change tCho/NAA Gray Matter RANO Response Assessment26 1 123.94 4.05 24.95 −12.89 −3.57 SD 2 −24.83 −8.94 33.59 −4.44 13.08 SD/PD* 3 5.35 −3.47 8.38 9.93 −4.51 SD 4 −27.15 −23.71 5.72 2.43 6.21 SD 5 −19.18 37.67 3.28 −12.81 11.65 SD 6 −7.72 −22.19 10.08 −19.42 10.04 PD 7 −28.17 −16.29 14.55 1.95 9.17 SD 8 −32.11 −15.96 4.68 0.64 −3.43 SD 9 −37.56 −3.74 6.12 21.37 22.80 SD 10 −13.95 −4.12 17.50 17.75 8.96 PR 11 −4.43 −7.94 15.56 −4.31 8.28 SD 12 −45.23 −21.59 7.96 −14.76 −1.37 SD 13 −47.67 −4.96 15.79 −6.40 10.69 SD 14 −46.51 −13.88 −4.55 −8.88 12.89 PR 15 8.25 3.75 −0.28 13.17 −1.10 SD 16 −24.17 7.50 −23.48 −6.78 5.19 PR 17 −55.76 9.58 −21.53 23.58 100.96 PR 18 −33.70 −19.41 −24.89 −3.03 −14.85 PR Median % change of medians (interquartile range) −25.99%(−39.48 to −6.90)(−55.76 to 123.94) −6.45%(−17.07 to 3.83)(−23.71 to 37.67) 7.04%(−1.35 to 15.62)(−24.89 to 33.59) −3.67%(−9.86 to 10.74)(−19.42 to 23.58) 8.62%(−1.89 to 11.96)(−14.85 to 100.96) Summary SD = 11PR = 5PD = 1SD/PD = 1 P value for median % change(vs 0%) P = .006 P = .06 P = .12 P = .80 P = .02 -
Note:—Listed values are compared to 0% change (null value) for each of the 5 parameters. RANO response assessment key: PR indicates partial response; SD, stable disease; PD, progression of disease. For patient 2(*), the targeted treated primary tumor was classified as SD; however, new discontinuous leptomeningeal enhancement designated the overall response as PD.
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- Table 3:
Comparison of median percent change in tCho/NAA ratios between the 5 different ROI groups
Enhance vs. Control Enhance vs. Nonenhance Enhance vs. Gray Enhance vs. White Nonenhance vs. Control Nonenhance vs. Gray Nonenhance vs. White Control vs. Gray Control vs. White White vs. Gray P value .005 .03 .004 .006 .11 .008 .058 .91 .23 .039 -
Note:—The median percent change values (of all 18 patients' individual median percent change values) are compared between the 5 different brain categories.
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