Prediction of recurrent glioblastoma after laser interstitial thermal therapy: The role of diffusion imaging

Abdelkader Mahammedi; Suha Bachir; Edward J Escott; Gene H Barnett; Alireza M Mohammadi; Mykol Larvie

doi:10.1093/noajnl/vdz021

Prediction of recurrent glioblastoma after laser interstitial thermal therapy: The role of diffusion imaging

Neurooncol Adv. 2019 Aug 20;1(1):vdz021. doi: 10.1093/noajnl/vdz021. eCollection 2019 May-Dec.

Authors

Abdelkader Mahammedi¹, Suha Bachir², Edward J Escott³, Gene H Barnett^{4

5}, Alireza M Mohammadi^{4

5}, Mykol Larvie¹

Affiliations

¹ Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
² Department of Pediatrics and Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Department of Radiology, University of Kentucky, Lexington, Kentucky.
⁴ Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
⁵ Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.

Abstract

Background: Evaluate the utility of diffusion-weighted imaging (DWI) for the assessment of local recurrence of glioblastoma (GBM) on imaging performed 24 h following MRI-guided laser interstitial thermal therapy (LITT). We hypothesize that microscopic peritumoral infiltration correlates with early subtle variations on DWI images and apparent diffusion coefficient (ADC) maps.

Methods: Of 64 patients with GBM treated with LITT, 39 had MRI scans within 24 h after undergoing LITT. Patterns on DWI images and ADC maps 24 h following LITT were correlated with areas of future GBM recurrence identified through coregistration of subsequent MRI examinations. In the areas of suspected recurrence within the periphery of post-LITT lesions, signal intensity values on ADC maps were recorded and compared with the remaining peritumoral ring.

Results: Thirty-nine patients with GBM met the inclusion criteria. For predicting recurrent GBM, areas of decreased DWI signal and increased signal on ADC maps within the expected peritumoral ring of restricted diffusion identified 24 h following LITT showed 86.1% sensitivity, 75.2% specificity, and high correlation (r = 0.53) with future areas of GBM recurrence (P < .01). Areas of future recurrence demonstrated a 37% increase in the ADC value (P < .001), compared with findings in the surrounding treated peritumoral region. A significantly greater area under the receiver operating characteristics curve was determined for ADC values (P < .01).

Conclusions: DWI obtained 24 h following LITT can help predict the location of GBM recurrence months before the development of abnormal enhancement. This may alter future treatment planning, perhaps suggesting areas that may be targeted for additional therapy.

Keywords: MRI-guided laser interstitial thermal therapy; apparent diffusion coefficient; diffusion-weighted image; glioblastoma; laser interstitial thermal therapy.