Response-driven imaging biomarkers for predicting radiation necrosis of the brain

Mohammad Reza Nazem Zadeh, Christopher H. Chapman, Thomas Chenevert, Theodore S. Lawrence, Randall K. Ten Haken, Christina I. Tsien, Yue Cao

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Radiation necrosis is an uncommon but severe adverse effect of brain radiation therapy (RT). Current predictive models based on radiation dose have limited accuracy. We aimed to identify early individual response biomarkers based upon diffusion tensor (DT) imaging and incorporated them into a response model for prediction of radiation necrosis. Twenty-nine patients with glioblastoma received six weeks of intensity modulated RT and concurrent temozolomide. Patients underwent DT-MRI scans before treatment, at three weeks during RT, and one, three, and six months after RT. Cases with radiation necrosis were classified based on generalized equivalent uniform dose (gEUD) of whole brain and DT index early changes in the corpus callosum and its substructures. Significant covariates were used to develop normal tissue complication probability models using binary logistic regression. Seven patients developed radiation necrosis. Percentage changes of radial diffusivity (RD) in the splenium at three weeks during RT and at six months after RT differed significantly between the patients with and without necrosis (p = 0.05 and p = 0.01). Percentage change of RD at three weeks during RT in the 30 Gy dose-volume of the splenium and brain gEUD combined yielded the best-fit logistic regression model. Our findings indicate that early individual response during the course of RT, assessed by radial diffusivity, has the potential to aid the prediction of delayed radiation necrosis, which could provide guidance in dose-escalation trials.

Original languageEnglish (US)
Pages (from-to)2535-2547
Number of pages13
JournalPhysics in medicine and biology
Issue number10
StatePublished - May 21 2014
Externally publishedYes


  • biomarker
  • brain
  • diffusion tensor imaging
  • radiation necrosis
  • response-driven models

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Response-driven imaging biomarkers for predicting radiation necrosis of the brain'. Together they form a unique fingerprint.

Cite this