JOURNAL ARTICLE

Evidence that MR diffusion tensor imaging (tractography) predicts the natural history of regional progression in patients irradiated conformally for primary brain tumors

Anitha Priya Krishnan, Isaac M Asher, Delphine Davis, Paul Okunieff, Walter G O'Dell
International Journal of Radiation Oncology, Biology, Physics 2008 August 1, 71 (5): 1553-62
18538491

PURPOSE: Stereotactic radiotherapy (SRT) is fast becoming the method of choice for treatment of nonsuperficial brain lesions. SRT treatment plans of malignant brain tumors typically incorporate a 20-mm isotropic margin to account for microscopic tumor spread; however, distant or progressive tumors occur outside this margin. Our hypothesis is that paths of elevated water diffusion may provide a preferred route for transport or migration of cancer cells. If our hypothesis is correct, then future SRT treatment volumes could be modified to provide elongated treatment margins along the paths of elevated water diffusion, thereby creating a biologically better treatment plan that may reduce the incidence of progression.

METHODS AND MATERIALS: Magnetic resonance diffusion tensor imaging (DTI) datasets were acquired on patient subjects before the appearance of >5 mm diameter progressive lesions or secondary tumors. DTI was performed using an echo-planar imaging sequence on a 1.5T clinical General Electric scanner with voxel dimensions of 0.98 x 0.98 x 6 mm. After SRT, patients were given repeated magnetic resonance imaging follow-ups at regular intervals to identify early tumor progression. When progressive disease was detected, DTIstudio and FMRIB Software Library software was used to compute paths of preferred water diffusion through the primary tumor site and the site of progression.

RESULTS: Our preliminary results on 14 patient datasets suggest a strong relationship between routes of elevated water diffusion from the primary tumor and the location of tumor progression.

CONCLUSIONS: Further investigation is therefore warranted. Future work will employ more sophisticated fiber analysis in a prospective study.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
18538491
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.