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Updated: Jun 13, 2026
Digital Spatial Profiling for Characterization of the Microenvironment in Adult-Type Diffusely Infiltrating Glioma
Published on: September 13, 2022
Infiltrative patterns of glioblastoma spread detected via diffusion MRI after treatment with cediranib
Elizabeth R Gerstner1, Poe-Jou Chen, Patrick Y Wen
1Departments of Neurology, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA. egerstner@partners.org
Abstract:
To evaluate the role of apparent diffusion coefficient (ADC) imaging in assessing tumor cell infiltration after treatment with the antivascular endothelial growth factor (anti-VEGF) agent, cediranib, we prospectively analyzed diffusion MRI scans from 30 patients participating in a Phase II trial of cediranib for recurrent glioblastoma. A patient-specific threshold was selected below which ADC values were determined to be abnormally low and suggestive of tumor. We determined the percent of low ADC in the FLAIR hyperintensity surrounding the enhancing tumor and then visualized the location of these low ADC voxels. The percent volume of the FLAIR hyperintensity comprised by low ADC increased significantly from baseline (2.3%) to day 28 (2.9%), day 56 (5.0%), and day 112 (6.3%) of treatment with cediranib suggesting increasing infiltrative tumor in some patients. Visualization of the location of the low ADC voxels suggested regions of tumor growth that were not visible on contrast-enhanced MRI. ADC maps can be used to suggest regions of infiltrative tumor cells with anti-VEGF therapy and should be validated in future studies.
Insights
Apparent diffusion coefficient (ADC) imaging may detect increasing tumor cell infiltration during anti-VEGF therapy for recurrent glioblastoma. Low ADC values in FLAIR hyperintensity suggest tumor growth not visible on standard MRI scans.
Area of Science:
- Neuroradiology
- Oncology
- Medical Imaging
Background:
- Recurrent glioblastoma poses significant treatment challenges.
- Anti-VEGF agents like cediranib target tumor vasculature.
- Assessing treatment response and tumor infiltration is crucial.
Purpose of the Study:
- To evaluate apparent diffusion coefficient (ADC) imaging for assessing tumor cell infiltration.
- To determine the role of ADC in patients treated with cediranib for recurrent glioblastoma.
Main Methods:
- Prospective analysis of diffusion MRI scans from 30 patients in a Phase II trial.
- Utilized a patient-specific threshold for low ADC values indicative of tumor.
- Quantified and visualized low ADC regions within FLAIR hyperintensity.
Main Results:
- The percentage of low ADC volume within FLAIR hyperintensity significantly increased over 112 days of cediranib treatment (2.3% to 6.3%).
- Increased low ADC suggested progressive infiltrative tumor in some patients.
- Visualized low ADC voxels identified tumor growth regions not apparent on contrast-enhanced MRI.
Conclusions:
- Apparent diffusion coefficient (ADC) imaging can suggest infiltrative tumor cell regions during anti-VEGF therapy.
- ADC mapping may provide insights into tumor behavior beyond standard contrast-enhanced MRI.
- Further validation of ADC imaging in anti-VEGF therapy studies is warranted.
