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Abstract #0837

Persistent Restricted Diffusion Abnormalities in Bevacizumab-Treated Glioma Patients: Relationship to Outcomesχ

Sandy Mong1, Ben M. Ellingson, Timothy F. Cloughesy2, Kim J. Hyun3, Albert Lai2, Phioanh Leia Nghiemphu2, Leili Mirsadraei4, William H. Yong4, Whitney B. Pope3

1Radiology , UCLA, Los Angeles, CA, United States; 2Neurology, UCLA; 3Radiology, UCLA; 4Pathology, UCLA

The aim of this study was to characterize the evolution and prognostic significance of persistent diffusion restriction abnormalities in patients with malignant glioma treated with bevacizumab. These patients demonstrated greater time to progression, time to survival from initiation of bevacizumab treatment and overall survival compared to matched controls. Advanced imaging correlated these diffusion signal abnormalities with hypoperfusion and decreased activity on PET scans. Histopathological examination of a resection specimen confirmed necrosis in one patient. Thus, the presence of diffusion restricted lesions in patients with malignant glioma appears to reflect treatment effect rather than hypercellular tumor in a majority of cases.

Keywords

abnormalities abnormality abscess absence activity acute advanced aggressive alone analyzed applied atypical barrier biopsy blood brain chemotherapies chronic clinical coefficient cohort comparing computed confirmed consent consistent content controls correlate correlation criteria curves days debated decreased decreases decreasing define described developed development diagnosis diffusion either emerging endothelial enhancement enhancing fact faintly findings free grade grades granted greater growing hemorrhage histology history hypothesis hypoxia included inclusion increasing induced initial initiation institutional intracellular irradiation least lesion lesions localize longer matched measures median membranes models months near necrosis noted observations occurred occurs onset outcomes overall pathology patients persisted persistent persistently pope positive predicted presence previous progression proxy radiology rank rather recurrent reduces reflecting relationship representative resection respectively response rest restricted restriction review score selected setting significance significantly similarly site spatially specimens spectrum stable student studies subsequent suggests support surgical survival sustained targeted temporal therapeutic though towards treated treatment trended tumor unpaired uptake vascular versus volume