Nimg-36. Mr Perfusion Is a Better Predictor of Tumor Recurrence and Treatment Response Than Standard Mri in Some Oligodendroglioma Patients
Year: 2022
Type: conference-abstract
Abstract: Dynamic susceptibility contrast (DSC) perfusion MRI (pMRI) has proven efficacy in the evaluation of glioma grade, progression and response to therapy. While not currently integrated within RANO (Response Assessment in Neuro Oncology) criteria, pMRI is often assessed alongside standard imaging of astrocytic glioma. In contrast, evaluation of pMRI in oligodendroglioma, has been less well-studied despite its potential to evaluate the comparatively greater vascularity of its “chicken-wire” capillary networks. Moreover, standard imaging to evaluate oligodendroglioma course can be confounded by slow-growing enhancement that does not meet RANO threshold for progression, or disease control despite low or absent radiographic response, and radiation-induced leukoencephalopathy resembling hyperintense changes on T2w and FLAIR imaging. Consequently, there is a clinical need to understand the potential role of pMRI in the evaluation of oligodendroglioma. As an initial step, we present here a case study of a patient with oligodendroglioma for which pMRI bested standard imaging in evaluation throughout radiographic disease surveillance. A 32 y/o gentleman with oligodendroglioma WHO grade 2 (IDH mutant, 1p19q codeletion) completed standard treatment, including surgical resection, irradiation, and chemotherapy. During surveillance imaging, a region of hyperperfusion on pMRI developed. However, since standard imaging was stable, RANO criteria was not met and observation was continued without intervention. Subsequent standard imaging demonstrated clear radiographic progression, reflecting the radiographic findings of pMRI but with delayed manifestation. Systemic chemotherapy was resumed with successively stable standard MR imaging. In contrast, the previous region of hyperperfusion improved over serial pMRI, and more consistently mirrored the patient’s clinical course. This case illustrates the timely radiographic importance of pMRI in assessing stability of tumor as well as treatment response. Considerations for the inclusion of pMRI within RANO criteria should be explored further.
Source: Neuro-Oncology
Institution: Medical College of Wisconsin
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4309015218