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Multimodality approach to predicting response of vestibular schwannomas to radiation therapy Twiss, Megan Margaret Jean

Abstract

Despite that most vestibular schwannomas are successfully treated with radiotherapy, current follow-up protocols entail years of serial magnetic resonance imaging (MRI) scans to ensure cessation of growth. This pilot study sought to identify early predictors of radiation treatment response using a non-invasive multi-modality imaging approach. We hypothesized that by combining information acquired from dynamic contrast-enhanced MRI (DCE-MRI), diffusion tensor imaging (DTI), and L-¹¹C-methionine positron emission tomography (MET-PET) treatment response could be identified sooner than the current several year waiting period. This thesis presents the baseline MRI and MET-PET results of the pilot study acquired to-date with follow-up data to be acquired in the next six months. Baseline results suggest that DTI and DCE-MRI yield information that may be useful in identifying the response of vestibular schwannomas to radiotherapy. In particular, vestibular schwannomas display elevated mean diffusion coefficients relative to the contra-lateral cerebellum. Also, the novel use of arterial input functions derived from the anterior inferior cerebellar arteries has led to the successful implementation of DCE-MRI pharmaco-kinetic models which may be used to quantitatively monitor tumor response to radiotherapy. Furthermore, MET-PET has shown promise as a tool for evaluating response as all tumors exhibited enhancement under this modality as compared to the contra-lateral side of the brain. Single-voxel spectroscopy with 3T MRI has proven to be a poor technique with which to examine vestibular schwannomas since only two of eight spectra were acquired successfully. All of the techniques that have shown promise as investigatory tools of tumor response can potentially be implemented clinically in the near future.

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Attribution-NonCommercial-NoDerivatives 4.0 International

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