Target Volume Determination 2015

Spectroscopic imaging

MR Spectroscopy

• Glioma

1 H SI

Progression

Radionecrosis

Lactate

Lipids

Cho

NAA

Cho Cr

[ppm] 4.0 3.0 2.0 1.0

Spectroscopy

Lipids

Lipids

[ppm] 4.0 3.0 2.0 1.0

NAA

NAA

[ppm] 4.0 3.0 2.0 1.0

Cho

[ppm] 4.0 3.0 2.0 1.0

Schlemmer et al. AJNR 2001

Pseudoreponse

RANO* Response criteria in CNS tumors

PET and PET/CT

Criterion

CR

PR

SD

PD

• Grading: Characterization by different tracers – 11C-methionine (MET), – 18F-fluoroethyl-L-tyrosine (FET)

T1 Gd-enhancing disease

None

≥50% decrease <50% decrease but <25% increase

≥25% incrase

T2/FLAIR lesion Stable or decreased

Stable or decreased

Stable or decreased

Increased

New lesion

None

None

None

Present

Corticosteroids needed

None

Stable or less

Stable or less

N/Aor more

Clinical status Stable or improved

Stable or improved

Stable or improved

Deteriorated

Requirement for response

All

All

All

Any

* RANO = Response assessment in neuro-oncology

Grosu et al. Strahlenther Onkol 2005

Wen PN et al. JCO 28:1963-1972 (2010)