Importance of Pre-treatment Fractional Anisotropy Value in Predicting Volumetric Response in Patients with Meningioma Treated with Gamma Knife Radiosurgery

Author(s): Dilek H. Cesme*, Alpay Alkan, Lutfullah Sari, Fatma Yabul, Hafize O. Temur, Mahmut E. Aykan, Mehmet H. Seyithanoglu, Mustafa A. Hatiboglu

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 17 , Issue 7 , 2021

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Graphical Abstract:


Background: The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed.

Objective: This study was conducted to determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between Total Tumor Volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings.

Methods: Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean Diffusivity (MD), Fractional Anisotropy (FA), Radial Diffusivity (RD), and TTV of tumour were determined. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered group 2. The relationships between MD, RD, and FA values and TTV were investigated.

Results: A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, RD, and MD values after radiosurgery.

Conclusion: Detection of low FA values due to the poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.

Keywords: Gamma knife radiosurgery, meningioma, diffusion tensor imaging, fractional anisotropy, radiosurgery, mean diffusivity, tumor volume.

Aslan K, Gunbey HP, Tomak L, Incesu L. The diagnostic value of using combined mr diffusion tensor ımaging parameters to differentiate between low- and high- grade menengioma. Br J Radiol 2018; 91(1088): 20180088.
Nguyen EK, Nguyen TK, Boldt G, Louie AV, Bauman GS. Hypofractionated stereotactic radiotheraphy for ıntracranial menengioma: A systematic review. Neurooncol Pract 2019; 6(5): 346-53.
Fatima N, Meola A, Pollom E, Chaudhary N, Soltys S, Chang SD. Stereotactic radiosurgery in large ıntracranial menengiomas: A systematic review. World Neurosurg 2019; 129: 269-75.
Speckter H, Bido J, Hernandez G, et al. Prognostic value of diffusion tensor imaging parameters for Gamma Knife radiosurgery in meningiomas. J Neurosurg 2016; 125(Suppl. 1): 83-8.
[] [PMID: 27903190]
Ding D, Xu Z, McNeill IT, Yen CP, Sheehan JP. Radiosurgery for parasagittal and parafalcine meningiomas. J Neurosurg 2013; 119(4): 871-7.
[] [PMID: 23930861]
Louis DN, Perry A, Reifenberger G, et al. The 2016 world health organization classification of tumors of the central nervous system: A summary. Acta Neuropathol 2016; 131: 803-20.
Mansouri A, Larjani S, Klironomos G, et al. Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas. J Neurosurg 2015; 123: 1294-300.
Santacroce A, Walier M, Régis J, et al. Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 2012; 70: 32-9.
Sheehan JP, Starke RM, Kano H, et al. Gamma Knife radiosurgery for posterior fossa meningiomas: A multicenter study. J Neurosurg 2015; 122: 1479-89.
Sheehan JP, Starke RM, Kano H, et al. Gamma Knife radiosurgery for sellar and parasellar meningiomas: A multicenter study. J Neurosurg 2014; 120: 1268-77.
Astner ST, Theodorou M, Dobrei-Ciuchendea M, et al. Tumor shrinkage assessed by volumetric MRI in the long-term follow-up after stereotactic radiotherapy of meningiomas. Strahlenther Onkol 2010; 186: 423-9.
Jolapara M, Kesavadas C, Radhakrishnan VV, et al. Role of diffusion tensor imaging in differentiating subtypes of meningiomas. J Neuroradiol 2010; 37: 277-83.
Toh CH, Castillo M, Wong AM, et al. Differentiation between classic and atypical meningiomas with use of diffusion tensor imaging AJNR Am J Neuroradiol 2008; 29: 1630-5.
Wang S, Kim S, Zhang Y, et al. Determination of grade and subtype of meningiomas by using histogram analysis of diffusion-tensor imaging metrics. Radiology 2012; 262: 584-92.
Kashimura H, Inoue T, Ogasawara K, et al. Prediction of meningioma consistency using fractional anisotropy value measured by magnetic resonance imaging. J Neurosurg 2007; 107: 784-7.
Tropine A, Dellani PD, Glaser M, et al. Differentiation of fibroblastic meningiomas from other benign subtypes using diffusion tensor imaging. J Magn Reson Imaging 2007; 25: 703-8.
Youlin G, Dong L, Zhiyuan Z, et al. Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients. Neurosurg Focus 2019; 46(6): E7.
Specter H, Bido J, Hernandez G, et al. Pretreatment texture analysis of routine MR ımages and shape analysis of the diffusion tensor for prediction of volumetric response after radiosurgery for menengioma. J Neurosurg 2018; 129: 31-7.
Di Franco R, Borzillo V, Ravo V, et al. Radiosurgery and stereotactic radiotherapy with cyberknife system for meningioma treatment. Neuroradiol J 2018; 31: 18-26.
Fatima N, Meola A, Pollom EL, Soltys SG, Chang SD. Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: A systematic review and meta-analysis. Neurosurg Focus 2019; 46: 6-E2.
Flannery T, Poots J. Gamma knife radiosurgery for Meningioma. Prog Neurol Surg 2019; 34: 91-9.
Pinzi V, Fariselli L, Marchetti M, Scorsetti M, Navarria P. Stereotactic radiotherapy for parasagittal and parafalcine meningiomas: patient selection and special considerations. Cancer Manag Res 2019; 11: 10051-60.
Huang RY, Bi WL, Weller M, et al. Proposed response assessment and endpoints for meningioma clinical trials: Report from the Response Assessment in Neuro-Oncology Working Group. Neuro-oncol 2019; 21(1): 26-36.
[] [PMID: 30137421]
Kondziolka D, Shin SM, Brunswick A, Kim I, Silverman JS. The biology of radiosurgery and its clinical applications for brain tumours. Neuro Oncol 2015; 17: 29-44.
Romani R, Tang WJ, Mao Y, et al. Diffusion tensor magnetic resonance imaging for predicting the consistency of intracranial meningiomas. Acta Neurochir (Wien) 2014; 56: 1837-45.

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Article Details

Year: 2021
Published on: 28 January, 2021
Page: [871 - 877]
Pages: 7
DOI: 10.2174/2213335608999210128182047

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