Learning objectives
Glioblastoma multiforme (GBM),
the most common primary brain tumor in adults,
is usually rapidly fatal.
Importance of preoperative MR imaging of GBM are proved predictors in survival of those patients,
especially if there is extent necrosis,
presence of tumor cysts,
extensive oedema,
multifocality.
Evaluation of early imaging response during therapy became more significant with standard therapy protocols which consists of maximal surgical resection,
radiotherapy and concomitant and adjuvant chemotherapy with Temozolomid.
Background
A total of 37 patients,
24 male and 13 female,
mean age about 51±18 years,
were evaluated from July 2011 to December 2012.
We used RANO criteria to compare radiological signs prior to three weeks after RT/HT,
then our patients were followed up every two months.
Early radiological progression (ERP) was defined as the qualitative interpretation of radiological progression based on abnormal post contrast enhancement on T1-Weighted Images (T1W) and T2- Weighted Images (T2W),
Fluid Attenuated Inversion Recovery (FLAIR) non enhancement,
non target lesions.
Advanced...
Imaging findings OR Procedure details
MRI images were acquired with Magnetom Siemens Avanto1.5 T with following protocol: T1W/TSE pre and postcontrast in axial,
coronal and sagittal plane,
T2W/TSE axial,
sagittal plane,
T2W/FLAIR coronal,
T2W/hemo,
DWI with ADC map.
PWI was prepared using DSC methods by EPI sequences.
MRS was done individually.
Comparison was done using Carestream Health PACS Viewer 11.3.2.
25 patients (67%) were found to have signs of early radiological progression,
5 of them (20%) were pseudoprogressors in follow up and correspond to stable disease.
12 patients who were...
Conclusion
RANO criteria gave us possibility to systematize radiological findings and more clearly explanations when we can expect pseudoprogression and progression.
References
1.Adam Gladwish,
Eng-Siew Koh,
Jeremy Hoisak et al : Evaluation of early imaging response criteria in glioblastoma multiforme.
Radiation oncology 2011,
6:121 Pub Med Abstract
2.Suzuki C,
Jacobsson H,
Hatschek T,
Torkzad MR,
Boden K,
Eriksson-Almy et al: Radiological measurements of tumor response to treatment: practical approaches et limitations.
Radiographics 2008,
28 (2):329-44 Pub Med Abstract
3.
IMI- RANO- critieria- booklet-Nov -2011