Diffusion-Weighted Imaging in the Follow-Up of Treated High-Grade Gliomas: Tumor Recurrence Versus Radiation Injury

Download Article

Authors : Vikas Rai


Diffusion-weighted (DW) MR imaging is a means to characterize and differentiate morphologic features, including edema, necrosis, and tumor tissue, by measuring differences in apparent diffusion coefficient (ADC). These researchers hypothesized that DW imaging has the potential to differentiate recurrent or progressive tumor growth from treatment- induced damage to brain parenchyma in high-grade gliomas after radiation therapy.


[1.] Brandsma, D., Stalpers, L., Taal, W., et al (2008) . Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. The Lancet Oncology, 9(5), 453-461.

[2.] Brismar, J., Roberson, G.H., Davis, K.R (1976). Radiation necrosis of the brain. Neuroradiological considerations with computed tomography. Neuroradiology, 12(2), 109-113

[3.] Chamberlain, M.C., Glantz, M.J., Chalmers, L., et al (2007) . Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastoma. - Journal of Neuro oncology, 82(1), 81-83.

[4.] Curnes, J., Laster, D., Bal,l M., et al (1986) . MRI of radiation injury to the brain. Am J Roentgenol, 147(1), 119-124.

[5.] Dellen, J.v., Danzinger, A (1978). Failure of computerized tomography to differentiate between radiation necrosis and cerebral tumor. S Afr Med J, 53(5), 171-172.

[6.] Henson, J.W., Ulmer, S., Harris, G.J (2008). Brain tumor imaging in clinical trials. Am J Neuroradiol, 29(3), 419-424.

[7.] Jain, R., Scarpace, L., Ellika, S., et al (2010). Imaging response criteria for recurrent gliomas treated with bevacizumab: Role of diffusion weighted imaging as an imaging biomarker. Journal of Neuro-Oncology ,96(3),423-431.

[8.] Kato, T., Yutaka, S., Tada, M., et al (1996). Long term evaluation of Radiation-induced brain damage by serial magnetic resonance imaging. Neurologia Medico-Chirurgica, 36(12), 870-876.

[9.] Kumar, A.J., Leeds, N.E., Fuller, G.N., et al (2000). Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiolog, ;217(2), 377-384.

[10.]   Lyubimova, N., Hopewell , J.W, (2004). Experimental evidence to support the hypothesis that damage to vascular endothelium plays the primary role in the development of late radiation-induced CNS injury. Br J Radiol; 77(918), 488-492.

[11.]   Macdonald, D.R., Cascino, T.L., Schold, S.C., et al, (1990). Response criteria for phase II studies of supratentorial malignant glioma. Journal of Clinical Oncology, 8(7), 1277-1280.

[12.]   Mikhael, M. (1978).Radiation necrosis of the brain: correlation between computed tomography, pathology, and dose distribution. J comput Assist Tomogr, 2(1), 71-80.

[13.]   Mullins, M.E., Barest, G.D., Schaefer, P.W., et al (2005). Radiation necrosis versus glioma recurrence: conventional MR imaging clues to diagnosis. AJNR Am J Neuroradiol , 26(8), 1967-1972.

[14.]   Sorensen, A.G., Batchelor, T.T., Wen, P.Y., et al (2008). Response criteria for glioma. Nat Clin Prac Oncol, 5(11), 634-644.

[15.]   Wen P.Y., Macdonald, D.R., Reardon, D.A., et al (2010). Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. Journal of Clinical Oncology, 28(11), 1963-1972.

[16.]   Zuniga, R., Torcuator, R., Jain, R., et al (2009). Efficacy, safety and patterns of response and recurrence in patients with recurrent high-grade gliomas treated with bevacizumab plus irinotecan. Journal of Neuro-Oncology, 91(3),329