Brainbloodvolume

“And all I ask of myself is that I hold together”
Neds Atomic Dustbin, Brainbloodvolume 1995

hqdefaultAs Jennifer Aniston might say on a shampoo commercial: watch out, here comes the science bit.

At every post-MRI results day appointment so far it has been a question of how much – if at all – my brain tumour has grown.

Low grade brain tumours grow very slowly, so any indication of more than a few millimetres growth over six months could show things have been changing up there. At my last results meeting in April there was no change in size.

But a few weeks later, my doctor called to tell me some extra results had come in. My tumour hadn’t grown, but it had an unexpectedly high vascularity.

As I wrote here at the time:

“I know not what that means, but I know it’s not good.”

And so I had a biopsy.

And during it, despite their best efforts, surgeons didn’t retrieve any grade III cells. My tumour, on a microscope slide at least, was still a grade II.

In other words, not yet malignant.

But the vascularity of my tumour was enough for my neurologist to err on the side of caution. He recommended I start radiotherapy and chemotherapy.

But, I thought, if the tumour hasn’t grown, and if they’ve retrieved no grade III cells, and I feel good, then why start treatment?

Ahead of my MRI two weeks ago, and my results day this coming Tuesday, I’ve been trying to find out what’s so special about this vascularity.

I discovered one of the things that strikes most concern among oncologists is a tumour’s ability to create its own blood vessels: angiogenesis.

The more angiogenesis that has taken place, the more blood the tumour can take up into the blood vessels it has created. And that means a higher tumour vascularity.

In brain tumours, vascularity is a good indicator that grade II brain tumours are transforming or are about to transform into grade III malignant ones.

A grade III isn’t totally bad news, but its certainly worse than grade II.

One 2006 paper analysed a group of low grade tumour patients, measuring their tumour’s base vascularity at the start of the study. It then looked at when the patient’s tumour transformed from grade II into grade III.

It concluded the tipping point for low grade tumours turning into higher grade ones was when a patient had a base vascularity of above 1.75.

In other words, of all those who had a vascularity lower than 1.75 when they entered the study, only 50% had transformed into high grade tumours a full 12 years later.

Of those who had a base vascularity above 1.75, that vital 50% (called the median) had transformed into high grade tumours just eight months later.

A 2008 study, written by my own neurologist with others, looked at the rate of change in the vascularity in tumours over a period of 36 months.

It concluded that when patients’ vascularity hardly changed from MRI to MRI their tumour didn’t transform into a higher grade during the period of the study.

But when the vascularity increased from MRI to MRI during the study, it was a strong indicator that transformation had or was about to take place.

In fact, this increase in vascularity was a far stronger predictor of transformation than a tumour’s growth, the side effects it creates or its intensity on the MRI images.

So even if your tumour isn’t growing or if your seizures aren’t getting worse, if your vascularity is increasing there’s a good chance transformation is underway.

I’m beginning to see why this week’s results meeting is an important one. And why my neurologist gave me that urgent call when those late test results came through.

Since diagnosis, my tumour has not grown any significant amount. My seizures have been extremely up and down.

But after my last MRI results appointment I was given my base vascularity score, its brain blood volume.

The score was 4.8.

This Tuesday I’ll learn for the first time whether that already high score has increased.

5 Comments

  1. Thanks Gideon, I know this isn’t great news for you but this information is incredibly useful and a real education. I had my six monthly mri last week and I will be asking questions about vascularity scores when I see my oncologist. On the plus side your neurologist is obviously a clever guy and you’re in good hands. You seem so well informed that it must help you feel confident in your decisions. Thoughts with you, keep up the great writing.

  2. They certainly tell you more during your review than I get, last time all I got was “no change see you in 6 months” I will be having another scan tomorrow which I was not sure about having as it is a month early and seems to be based on my G.P.’s guilt at telling me I was depressed and needed medicating for that!

    Good luck and keep the pedals turning………………..

    Neil

  3. Hi Gideon,
    So sorry that it’s not great news re the vascularity.
    Being well informed can be a bitter pill although generally I think it is the best course, it isn’t easy. So much adjusting for you & the family.
    Thinking of you today especially as you discuss options in your treatment.
    And we eat your chillies.
    Love to you all.
    Penny

  4. Thanks all. Great news is there’s been no change in the vascularity of my tumour!

    Yes, 4.8 is a high score for an oligodendroglioma, but there’s been no change, no growth and no enhancement. Come back in 6 months. The best possible news.

    Neil and Ben, it may interest you to know I’m writing a dummy/users guide to having a low grade glioma that is going to cover all these issues. Should be published in Oct or Nov sometime.

    Take care all.

    G

  5. Hi Just found this blog, other half keen cyclist (was until Dec 2012) when became so tired could not bring himself to go anymore. 1st seizure this year March 2013, hosp , CT then Biopsy Kings. Grade 11 ,…but with diffuse gliomotosis very very rare onc says altho grade 11 behaving in brain like grade 3 so chemo was started straight away even tho 1p19 etc co deletions were not favourable she still said it makes a difference sometimes anyway!? 1st MRI no change ‘stable’ We were told by Kings to do radio but Onc favoured just chemo we agreed. Bi lateral tumour bigger on left causes seizures on right. We go on with Temozolomide but dose has had to be lowered due to several complications at times,.Low platelets,white blood and infection. Still going on with it as of now, but the main problem seems to be with seizures and getting the right meds and dose!!! Any info on what you have tried? Seems not an exact science no one knows what will work or for how long etc. Pleased you are still able to cycle have said to other half he will get there we hope.

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