Abstract #0438

Progressing bevacizumab induced diffusion restriction is associated with coagulative necrosis surrounded by viable tumor and decreased overall survival in recurrent glioblastoma patients

Ha Son Nguyen¹, Nelson Milbach², Sarah L Hurrell², Elizabeth Cochran³, Jennifer Connelly⁴, Mona Al-Gizawiy², Joseph Bovi⁵, Scott D Rand², Kathleen M Schmainda², and Peter S. LaViolette^2,6

¹Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States, ²Radiology, Medical College of Wisconsin, Milwaukee, WI, United States, ³Pathology, Medical College of Wisconsin, Milwaukee, WI, United States, ⁴Neurology, Medical College of Wisconsin, Milwaukee, WI, United States, ⁵Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States, ⁶Biophysics, Milwaukee, WI, United States

It is the standard of care to initiate bevacizumab therapy for patients with recurrent glioblastoma. Some patients develop areas of diffusion restriction on diffusion imaging following the onset of therapy. We recruited five patients with this condition to donate their brains postmortem. A histological analysis was performed and compared to MR images to discover what caused the diffusion restriction. It was found to be coagulative necrosis surrounded by viable hypercellular tumor. A second population study shows that patients with progressively expanding diffusion restriction had a significantly lower survival compared to those without.

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