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Neuro Oncol. 2014 Jun;16(6):880-8. doi: 10.1093/neuonc/not216. Epub 2014 Jan 15.

Dynamic-susceptibility contrast agent MRI measures of relative cerebral blood volume predict response to bevacizumab in recurrent high-grade glioma.

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Department of Radiology, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S., M.P., S.D.R.); Department of Biophysics, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S.); Translational Brain Tumor Research Program, Medical College of Wisconsin, Milwaukee Wisconsin (K.M.S., J.C., S.D.R., W.M., M.G.M.); Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin (J.C., M.G.M.); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (R.G.H); Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin (J.C., W.M., M.G.M.).



The anti-VEGF antibody, bevacizumab, is standard treatment for patients with recurrent glioblastoma. In this setting, traditional anatomic MRI methods such as post-contrast T1-weighted and T2-weighted imaging are proving unreliable for monitoring response. Here we evaluate the prognostic significance of pre- and posttreatment relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast MRI to predict response to bevacizumab.


Thirty-six participants with recurrent high-grade gliomas who underwent rCBV imaging 60 days before and 20-60 days after starting bevacizumab treatment were enrolled. Tumor regions of interest (ROIs) were determined from deltaT1 maps computed from the difference between standardized post and precontrast T1-weighted images. Both pre- and posttreatment rCBV maps were corrected for leakage and standardized (stdRCBV) to a consistent intensity scale. The Kaplan-Meier method was used to determine if either the pre- or post-bevacizumab stdRCBV within the tumor ROI was predictive of overall survival (OS) or progression free survival (PFS).


The OS was significantly longer if either the pre- (380d vs 175d; P=.0024) or posttreatment stdRCBV (340d vs 186d; P = .0065) was <4400. The posttreatment stdRCBV was also predictive of PFS (167d vs 78d; P = .0006). When the stdRCBV values were both above versus both below threshold, the OS was significantly worse (100.5d vs 395d; P < .0001). With a 32.5% decrease in stdRCBV, the risk of death was reduced by about 68% but increased by 140% with a 29% increase in stdRCBV.


Standardized rCBV is predictive of OS and PFS in patients with recurrent high-grade brain tumor treated with bevacizumab.


DSC; MRI; bevacizumab; brain tumor; perfusion; rCBV

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