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Perfusion magnetic resonance imaging changes in normal appearing brain tissue after radiotherapy in glioblastoma patients may confound longitudinal evaluation of treatment response

Markus Fahlström
Markus Fahlström
, 
Erik Blomquist
Erik Blomquist
, 
Tufve Nyholm
Tufve Nyholm
 and 
Elna-Marie Larsson
Elna-Marie Larsson
   | Jun 06, 2018
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Article Category: Research Article
Published Online: Jun 06, 2018
Page range: 143 - 151
Received: Jan 17, 2018
Accepted: Apr 04, 2018
DOI: https://doi.org/10.2478/raon-2018-0022
© 2018 Markus Fahlström, Erik Blomquist, Tufve Nyholm, Elna-Marie Larsson, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Dose region distribution with corresponding pre-fractionated radiotherapy (pre-FRT) Gd-T1w image. Representative dose region distribution with corresponding pre-FRT GD-T1w image for one patient. Dose distribution was divided into seven binary regions (0–5 Gy, 5–10 Gy, 10–20 Gy, 20–30 Gy, 30–40 Gy, 40–50 Gy and 50–60 Gy). Resection cavity, post-FRT effects and tumour tissue were excluded.
Dose region distribution with corresponding pre-fractionated radiotherapy (pre-FRT) Gd-T1w image. Representative dose region distribution with corresponding pre-FRT GD-T1w image for one patient. Dose distribution was divided into seven binary regions (0–5 Gy, 5–10 Gy, 10–20 Gy, 20–30 Gy, 30–40 Gy, 40–50 Gy and 50–60 Gy). Resection cavity, post-FRT effects and tumour tissue were excluded.

Figure 2

Longitudinal change in global normalised cerebral blood volume (nCBV) and normalised cerebral blood flow (nCBF). Global nCBV and nCBF (mean and 95% CI) graphically displayed for the different examinations in consecutive order. Derived P-values are included, and emphasised in bold and italics if less than 0.05. Corresponding table for regional nCBV and nCBF can be found in S1 and S2 Figures.
Longitudinal change in global normalised cerebral blood volume (nCBV) and normalised cerebral blood flow (nCBF). Global nCBV and nCBF (mean and 95% CI) graphically displayed for the different examinations in consecutive order. Derived P-values are included, and emphasised in bold and italics if less than 0.05. Corresponding table for regional nCBV and nCBF can be found in S1 and S2 Figures.

Figure 3

Dose-dependent relative change and linear regression model for normalised cerebral blood volume (nCBV). Shows regional relative change for nCBV and derived line regression (line and equation). Corresponding figure for normalised cerebral blood flow (nCBF) can be found in S3 Figure.
Dose-dependent relative change and linear regression model for normalised cerebral blood volume (nCBV). Shows regional relative change for nCBV and derived line regression (line and equation). Corresponding figure for normalised cerebral blood flow (nCBF) can be found in S3 Figure.

Mean, standard error of mean (SEM) and change relative pre-fractionated radiotherapy (pre-FRT) for global nCBV and nCBF. Global normalised cerebral blood volume (nCBV) and normalised cerebral blood flow (nCBF) (mean and SEM), change in percentage relative pre-FRT (mean and SD) and derived P-values from a Wilcoxson matched-pair signed ranks test comparing post-FRT data with pre-FRT data. Corresponding table for regional nCBV and nCBF can be found in S2 Table

nCBVWMGM $\begin{array}{} \displaystyle \rm nCBV^{GM}_{WM} \end{array}$
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
ΔCBV 1.63±0.03 1.53±0.04 1.49±0.05 1.53±0.03
ΔnCBV (%) -6.7±7.7 -4.6±11.7 -6.0±9.3
p-value <0,0001 0,0535 <0,0001
nCBFWMGM $\begin{array}{} \displaystyle \rm nCBF^{GM}_{WM} \end{array}$
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
nCBF 1.60±0.03 1.53±0.03 1.37±0.04 1.46±0.03
ΔnCBF (%) -5.1±11.7 -12.5±11.4 -7.5±8.2
p-value 0,0057 <0,0001 <0,0001
nCBVWMWM $\begin{array}{} \displaystyle \rm nCBV^{WM}_{WM} \end{array}$
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
nCBV 1.10±0.03 1.06±0.03 1.03±0.03 1.05±0.03
ΔnCBV (%) -4.3±7.6 0.7±11.7 -3.6±11.9
p-value 0,0003 0,3818 0,1197
nCBFWMWM $\begin{array}{} \displaystyle \rm nCBF^{WM}_{WM} \end{array}$
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
nCBF 1.09±0.02 1.08±0.03 0.96±0.03 1.05±0.03
ΔnCBF (%) -3.1±7.7 -7.4±10.5 -3.4±10.3
p-value 0,0166 0,0002 0,2267
nCBVGMGM $\begin{array}{} \displaystyle \rm nCBV^{GM}_{GM} \end{array}$
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
nCBV 1.00±0.01 0.99±0.01 1.02±0.02 1.0±0.02
ΔnCBV (%) -0.9±4.0 1.7±5.7 -0.4±6.8
p-value 0,1629 0,184 0,6445
nCBFGMGM $\begin{array}{} \displaystyle \rm nCBF^{GM}_{GM} \end{array}$$ $
Pre-FRT FRTPost-1 FRTPost-2 FRTPost-3
nCBF 1.02±0.01 1.01±0.01 1.00±0.01 1.02±0.01
ΔnCBF (%) -0.1±5.1 -2.8±4.7 0.0±4.5
p-value 0,4922 0,0073 0,9252
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