Diffusion-Weighted Imaging in the Follow-up of Treated High-Grade Gliomas: Tumor Recurrence versus Radiation Injury

BACKGROUND AND PURPOSE: Diffusion-weighted (DW) MR imaging is a means to char-acterize and differentiate morphologic features, including edema, necrosis, and tumor tissue, by measuring differences in apparent diffusion coefficient (ADC). We hypothesized that DW imaging has the potential to differentiate recurrent or progressive tumor growth from treat-ment-induced damage to brain parenchyma in high-grade gliomas after radiation therapy. METHODS: We retrospectively reviewed follow-up conventional and DW MR images ob-tained starting 1 month after completion of radiation treatment with or without chemotherapy for histologically proved high-grade gliomas. Eighteen patients with areas of abnormal enhanc-ing tissue were identified. ADC maps were calculated from echo-planar DW images, and mean ADC values and ADC ratios (ADC of enhancing lesion to ADC of contralateral white matter) were compared with final diagnosis. Recurrence was established by histologic examination or by clinical course and a combination of imaging studies. RESULTS: Recurrence and nonrecurrence could be differentiated by using mean ADC values and ADC ratios. ADC ratios in the recurrence group showed significantly lower values (mean SD, 1.43 0.11) than those of the nonrecurrence group (1.82 0.07, P <.001). Mean ADC