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Magnetic Resonance Materials in Physics, Biology and Medicine
Published in: Magnetic Resonance Materials in Physics, Biology and Medicine 1/2022

01-02-2022 | Glioblastoma | Research Article

Evaluation of normal-appearing white matter with perfusion and diffusion MRI in patients with treated glioblastoma

Authors: Sinan Şahin, Ersen Ertekin, Tuna Şahin, Yelda Özsunar

Published in: Magnetic Resonance Materials in Physics, Biology and Medicine | Issue 1/2022

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Abstract

Objective

We tried to reveal how the normal appearing white matter (NAWM) was affected in patients with glioblastoma treated with chemo-radiotherapy (CRT) in the period following the treatment, by multiparametric MRI.

Materials and methods

43 multiparametric MRI examinations of 17 patients with glioblastoma treated with CRT were examined. A total of six different series or maps were analyzed in the examinations: Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps, Gradient Echo (GRE) sequence, Dynamic susceptibility contrast (DSC) and Arterial spin labeling (ASL) perfusion sequences. Each sequence in each examination was examined in detail with 14 Region of Interest (ROI) measurements. The obtained values were proportioned to the contralateral NAWM values and the results were recorded as normalized values. Time dependent changes of normalized values were statistically analyzed.

Results

The most prominent changes in follow-up imaging occurred in the perilesional region. In perilesional NAWM, we found a decrease in normalized FA (nFA), rCBV (nrCBV), rCBF (nrCBF), ASL (nASL)values (p < 0.005) in the first 3 months after treatment, followed by a plateau and an increase approaching pretreatment values, although it did not reach. Similar but milder findings were present in other NAWM areas. In perilesional NAWM, nrCBV values were found to be positively high correlated with nrCBF and nASL, and negatively high correlated with nADC values (r: 0.963, 0.736, − 0.973, respectively). We also found high correlations between the mean values of nrCBV, nrCBF, nASL in other NAWM areas (r: 0.891, 0.864, respectively).

Discussion

We showed that both DSC and ASL perfusion values decreased correlatively in the first 3 months and showed a plateau after 1 year in patients with glioblastoma treated with CRT, unlike the literature. Although it was not as evident as perfusion MRI, it was observed that the ADC values also showed a plateau pattern following the increase in the first 3 months. Further studies are needed to explain late pathophysiological changes. Because of the high correlation, our results support ASL perfusion instead of contrast enhanced perfusion methods.
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Metadata
Title
Evaluation of normal-appearing white matter with perfusion and diffusion MRI in patients with treated glioblastoma
Authors
Sinan Şahin
Ersen Ertekin
Tuna Şahin
Yelda Özsunar
Publication date
01-02-2022
Publisher
Springer International Publishing
Published in
Magnetic Resonance Materials in Physics, Biology and Medicine / Issue 1/2022
Print ISSN: 0968-5243
Electronic ISSN: 1352-8661
DOI
https://doi.org/10.1007/s10334-021-00990-5

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