diffusion mri is sensitive to brain tumor cell density clinical adc and cell density are negatively...
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![Page 1: Diffusion MRI is sensitive to brain tumor cell density Clinical ADC and cell density are negatively correlated (Sugahara, 1999; Lyng, 2000; Chenevert,](https://reader035.vdocuments.mx/reader035/viewer/2022070416/56649d825503460f94a68622/html5/thumbnails/1.jpg)
Diffusion MRI is sensitive to brain tumor cell density
Clinical ADC and cell density are negatively correlated
(Sugahara, 1999; Lyng, 2000; Chenevert, 2000; Gaurain, 2001; Nonomura, 2001; Guo, 2002; Chen, 2005; Hayashida, 2006; Manenti, 2008; Kinoshita, 2008)
ADC (or mean diffusion) = cell density (“hypercellularity”)ADC = cell density (“hypocellularity”)
Viable Tumor (Dark)
Necrotic Core
Edema
ADC Map
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
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Diffusion MRI is sensitive to brain tumor cell density
Tests at our laboratory have confirmed this relationship
- 17 glioma patients (WHO II-IV) underwent diagnostic stereotactic biopsy- Biopsy sites were spatially matched to pre-operative ADC maps
R2 = 0.7933; P < 0.001
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009From: Ellingson, et al. JMRI 2009, In Press
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The Functional Diffusion Map (fDM)(Moffat, 2005; 2006; Hamstra, 2005; 2008)
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 From: Ellingson, JMRI, 2009, In Press
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B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2009 SNO/CNS 2009B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
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B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2009 SNO/CNS 2009B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 From: Ellingson et al. J Neurooncol, 2009, In Press
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Early Detection of Brain Tumor Growth
T1+C
FLAIR
fDMs
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
HypercellularRegions (Blue)
Contrast-Enhancement(white)
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fDMs in Brain Tumor Progression
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
T1+C
FLAIR
fDM
3 mo. 6 mo. 9 mo. (Onset of symptoms)
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B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
fDMs in Progressive Disease (PD)
Hypercellularity
Hypercellularity
Hypercellularity
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fDM Results in Stable Disease (SD)
Treatment: Radiation + Temozolomide
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
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Treatment: Radiation + Temozolomide
fDM Results in Responding Disease (RD)
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
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fDM Results in Stable/Responding Disease (SD/RD)
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
Hypocellularity Hypocellularity
Hypocellularity
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fDMs are an early biomarker for cytotoxic and new anti-angiogenic treatments
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 Ellingson BM, J Neurooncol, Under Prep
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Results
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
• “fDM Responders” have significantly longer TTP after standard Tx– fDMs are a better predictor than tumor grade
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Results
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010 SNO/CNS 2009
• “fDM Responders” have significantly longer survival on bevacizumab– fDMs are better predictors than grade, age, or mono/combined therapy
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Graded fDMs Allow Visualization of Growing Tumor
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
+ Hypercellular+ Hypocellular
1 Mo. 2 Mo. 3 Mo. 4 Mo.
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Graded fDMs Allow Visualization of Growing Tumor
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
+ Hypercellular+ Hypocellular
7 Mo.5 Mo.3 Mo.
![Page 17: Diffusion MRI is sensitive to brain tumor cell density Clinical ADC and cell density are negatively correlated (Sugahara, 1999; Lyng, 2000; Chenevert,](https://reader035.vdocuments.mx/reader035/viewer/2022070416/56649d825503460f94a68622/html5/thumbnails/17.jpg)
Graded fDMs Allow Visualization of Growing Tumor
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
+ Hypercellular+ Hypocellular
5 Mo.4 Mo.2 Mo.
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Hyp
erc
ellu
lar
Hyp
oce
llula
r
Macrophages& Inflammatory Cells
Demyelination
Graded fDMs in Demyelination
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
Biopsy Diagnosis = Demyelination (Multiple Sclerosis)
3 Mo. 5 Mo. 7 Mo. 9 Mo.
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Graded fDMs: Radiation Necrosis vs. Tumor
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
Hyp
erc
ellu
lar
Hyp
oce
llula
r
T1+
CF
LAIR
Gra
ded
fDM
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Graded fDMs: Radiation Induced Changes
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
Hyp
erc
ellu
lar
Hyp
oce
llula
r
2 Mo. 3 Mo. 5 Mo. 8 Mo.
14 Mo. 18 Mo. 21 Mo. 23 Mo.
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Graded fDMs: Radiation Induced Changes
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
Hyp
erc
ellu
lar
Hyp
oce
llula
r
2 Mo. 4 Mo. 6 Mo.
10 Mo. 14 Mo.18 Mo.
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Graded fDMs Improve Tumor Localization/Grading in Stereotactic Needle Biopsy
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
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Graded fDMs Improve Tumor Localizationand Grading in Stereotactic Needle Biopsy
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
2 LesionsBiopsy (WHO II)
Hyp
erc
ellu
lar
Hyp
oce
llula
r
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Graded fDMs Improve Tumor Localization for Resection
B.M. Ellingson, Ph.D., Dept. of Radiology, Medical College of Wisconsin, 2010
Hyp
erc
ellu
lar
Hyp
oce
llula
r
ResectionCavity
Only 10% of Hypercellularregions were removed!