Distinguishing Pseudoprogression From True Early Progression in Isocitrate Dehydrogenase Wild-Type Glioblastoma by Interrogating Clinical, Radiological, and Molecular Features

Li, Mingxiao; Ren, Xiaohui; Dong, Gaochao; Wang, Jincheng; Jiang, Haihui; Yang, Cong; Zhao, Xuzhe; Zhu, Qinghui; Cui, Yong; Yu, Kefu; Lin, Shu-Chiang

doi:10.3389/fonc.2021.627325

Cited by 13 publications

(6 citation statements)

References 39 publications

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“…The difference to radiation necrosis is related both to the timing of presentation, i.e., 3–6 months for pseudoprogression and 1 year after radiation therapy in radiation necrosis, but also to the different pathophysiology whereby radiation necrosis presents as permanent damage to the brain tissue, necrosis, and vascular thrombosis [ 74 ]. Variable “timing” definitions and the blurred presentation between these two entities reported in published studies have important implications in terms of patient management, clinical trial enrolment, and treatment evaluation [ 75 ]. In fact, patients with pseudoprogression are notably characterized by a favorable clinical course.…”

Section: Clinical Applications Of Hemodynamic Imaging In Gliomas—partmentioning

confidence: 99%

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

Stumpo

Guida

Bellomo

et al. 2022

Cancers

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Gliomas, and glioblastoma in particular, exhibit an extensive intra- and inter-tumoral molecular heterogeneity which represents complex biological features correlating to the efficacy of treatment response and survival. From a neuroimaging point of view, these specific molecular and histopathological features may be used to yield imaging biomarkers as surrogates for distinct tumor genotypes and phenotypes. The development of comprehensive glioma imaging markers has potential for improved glioma characterization that would assist in the clinical work-up of preoperative treatment planning and treatment effect monitoring. In particular, the differentiation of tumor recurrence or true progression from pseudoprogression, pseudoresponse, and radiation-induced necrosis can still not reliably be made through standard neuroimaging only. Given the abundant vascular and hemodynamic alterations present in diffuse glioma, advanced hemodynamic imaging approaches constitute an attractive area of clinical imaging development. In this context, the inclusion of objective measurable glioma imaging features may have the potential to enhance the individualized care of diffuse glioma patients, better informing of standard-of-care treatment efficacy and of novel therapies, such as the immunotherapies that are currently increasingly investigated. In Part B of this two-review series, we assess the available evidence pertaining to hemodynamic imaging for molecular feature prediction, in particular focusing on isocitrate dehydrogenase (IDH) mutation status, MGMT promoter methylation, 1p19q codeletion, and EGFR alterations. The results for the differentiation of tumor progression/recurrence from treatment effects have also been the focus of active research and are presented together with the prognostic correlations identified by advanced hemodynamic imaging studies. Finally, the state-of-the-art concepts and advancements of hemodynamic imaging modalities are reviewed together with the advantages derived from the implementation of radiomics and machine learning analyses pipelines.

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Section: Clinical Applications Of Hemodynamic Imaging In Gliomas—partmentioning

confidence: 99%

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

Stumpo

Guida

Bellomo

et al. 2022

Cancers

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“…21 Imaging and early diagnosis of smaller volume recurrences is critical as they are often salvageable and now include expanded options like reirradiation. 22 History of seizures especially in the setting of oligodendrogliomas need not always represent progression. Hence, a holistic approach combining clinical history, tumour type and imaging findings needs to be considered in such cases and possibility of pseudoprogression needs to be ruled out before labelling recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…21 Imaging and early diagnosis of smaller volume recurrences is critical as they are often salvageable and now include expanded options like reirradiation. 22…”

Section: Discussionmentioning

confidence: 99%

Post-ictal changes presenting as late pseudoprogression on MRI and PET in a patient with diffuse glioma: Case report and brief literature review

et al. 2023

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Following completion of adjuvant radiation and chemotherapy imaging surveillance forms a major role in the management of diffuse gliomas. The primary role of imaging is to detect recurrences earlier than clinical symptomatology. Magnetic resonance imaging (MRI) is considered the gold standard in follow-up protocols owing to better soft tissue delineation and multiparametric nature. True recurrence can often mimic treatment-related changes, it is of paramount importance to differentiate between the two entities as the clinical course is divergent. Addition of functional sequences like perfusion, spectroscopy and metabolic imaging can provide further details into the microenvironment. In equivocal cases, a follow-up short interval imaging might be obtained to settle the diagnostic dilemma. Here, we present a patient with diagnosis of recurrent oligodendroglioma treated with adjuvant chemoradiation, presenting with seizures five years post-completion of chemotherapy for recurrence. On MRI, subtle new onset gyral thickening of the left frontal region with mild increase in perfusion and patchy areas of raised choline. FET-PET (fluoro-ethyltyrosine) showed an increased tumour-to-white matter (T/Wm) ratio favouring tumour recurrence. Based on discussion in a multi-disciplinary joint clinic, short interval follow-up MRI was undertaken at two months showing decrease in gyral thickening and resolution of enhancing areas in left frontal lobe. Repeat imaging one year later demonstrated stable disease status without further new imaging findings. Given the changes resolving completely without any anti-tumoral intervention, we conclude this to be peri-ictal pseudoprogression, being the second such case described in India.

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“…121,127,133,134 Whereas recurring tumors often have increased Cho due to higher cell membrane turnover, therapy-associated lesions frequently have slightly decreased NAA and substantially decreased lipid-Lac peaks. 121,127,135,136 In a recent meta-analysis of advanced MR imaging techniques, SVS had the highest diagnostic accuracy, reliably discerning treatment-related changes in patients with HGG. 137 Specific parameters in SVS may be highly sensitive to metabolic differences.…”

Section: Expanding Horizons: Improved Detection Of Infiltrated Tissue...mentioning

confidence: 99%

Application of 7T MRS to High-Grade Gliomas

McCarthy

Verma

Hangel

et al. 2022

AJNR Am J Neuroradiol

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MRS, including single-voxel spectroscopy and MR spectroscopic imaging, captures metabolites in high-grade gliomas. Emerging evidence indicates that 7T MRS may be more sensitive to aberrant metabolic activity than lower-field strength MRS. However, the literature on the use of 7T MRS to visualize high-grade gliomas has not been summarized. We aimed to identify metabolic information provided by 7T MRS, optimal spectroscopic sequences, and areas for improvement in and new applications for 7T MRS. Literature was found on PubMed using "high-grade glioma," "malignant glioma," "glioblastoma," "anaplastic astrocytoma," "7T," "MR spectroscopy," and "MR spectroscopic imaging." 7T MRS offers higher SNR, modestly improved spatial resolution, and better resolution of overlapping resonances. 7T MRS also yields reduced Cramér-Rao lower bound values. These features help to quantify D-2-hydroxyglutarate in isocitrate dehydrogenase 1 and 2 gliomas and to isolate variable glutamate, increased glutamine, and increased glycine with higher sensitivity and specificity. 7T MRS may better characterize tumor infiltration and treatment effect in high-grade gliomas, though further study is necessary. 7T MRS will benefit from increased sample size; reductions in field inhomogeneity, specific absorption rate, and acquisition time; and advanced editing techniques. These findings suggest that 7T MRS may advance understanding of high-grade glioma metabolism, with reduced Cramér-Rao lower bound values and better measurement of smaller metabolite signals. Nevertheless, 7T is not widely used clinically, and technical improvements are necessary. 7T MRS isolates metabolites that may be valuable therapeutic targets in highgrade gliomas, potentially resulting in wider ranging neuro-oncologic applications.

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Distinguishing Pseudoprogression From True Early Progression in Isocitrate Dehydrogenase Wild-Type Glioblastoma by Interrogating Clinical, Radiological, and Molecular Features

Cited by 13 publications

References 39 publications

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

Post-ictal changes presenting as late pseudoprogression on MRI and PET in a patient with diffuse glioma: Case report and brief literature review

Application of 7T MRS to High-Grade Gliomas

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