OPEN IN READ APP

Longitudinal Monitoring of Gd-DTPA Following Convection Enhanced Delivery in the Brainstem

Umberto Tosi, Mark M Souweidane
World Neurosurgery 2020 February 3
32028001

BACKGROUND: Convection-enhanced delivery (CED) has been introduced into contemporary therapeutic strategies for incurable brain neoplasms as diffuse intrinsic pontine glioma (DIPG). Therapeutic benefit in part is predictably dependent upon drug distribution within tumor. However, therapeutics can rarely be detected through conventional imaging techniques. Co-infusion of the tracer Gadolinium-diethylenetriaminepentacetate (Gd-DTPA) has been advocated to monitor drug distributive features including volume (Vd), tumor coverage, and efflux during and after administration. The kinetics of Gd-DTPA are unclear as longitudinal MRI is rarely performed. Understanding these changes would have important implications related to the timing of diagnostic imaging and reliance on tracers as surrogates of pharmacokinetic drug monitoring.

CASE DESCRIPTION: The behavior of Gd-DTPA as a surrogate is presented in a time-dependent fashion as measured by repeated MRI based on the case of a child with recurrent DIPG treated with an oncolytic virus (ICOVIR-5) delivered by CED with co-infused Gd-DTPA (1 mM, for a volume of 2000 μL). Initial Vd / Vi was 1.46. Gd-DTPA was observed up to 18 hours post CED but not thereafter.

CONCLUSIONS: This longitudinal imaging assessment provides a rare opportunity to better characterize the kinetics of surrogate tracers delivered by CED to the brainstem, highlighting the importance of immediate and longitudinal monitoring.

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

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
32028001
×

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"