Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

Abstract

Pseudoprogression may present as transient new or increasing enhancing lesions that mimic recurrent tumors in treated glioblastoma. The purpose of this study was to examine the utility of dynamic contrast enhanced T1 magnetic resonance imaging (DCE MRI) in differentiating between pseudoprogression and tumor progression and devise a cut-off value sensitive for pseudoprogression. We retrospectively examined 37 patients with glioblastoma treated with radiation and temozolomide after surgical resection that then developed new or increasing enhancing lesion(s) indeterminate for pseudoprogression versus progression. Volumetric plasma volume (Vp) and time-dependent leakage constant (Ktrans) maps were measured for the enhancing lesion and the mean and ninetieth percentile histogram values recorded. Lesion outcome was determined by clinical follow up with pseudoprogression defined as stable disease not requiring new treatment. Statistical analysis was performed with Wilcoxon rank-sum tests. Patients with pseudoprogression (n = 13) had Vp (mean) = 2.4 and Vp (90 %tile) = 3.2; and Ktrans (mean) = 3.5 and Ktrans (90 %tile) = 4.2. Patients with tumor progression (n = 24) had Vp (mean) = 5.3 and Vp (90 %tile) = 6.6; and Ktrans (mean) = 7.4 and Ktrans (90 %tile) = 9.1. Compared with tumor progression, pseudoprogression demonstrated lower Vp perfusion values (p = 0.0002) with a Vp (mean) cutoff <3.7 yielding 85 % sensitivity and 79 % specificity for pseudoprogression. Ktrans (mean) of >3.6 had a 69 % sensitivity and 79 % specificity for disease progression. DCE MRI shows lower plasma volume and time dependent leakage constant values in pseudoprogression than in tumor progression. A cut-off value with high sensitivity for pseudoprogression can be applied to aid in interpretation of DCE MRI.

MR perfusion-weighted imaging in the evaluation of high-grade gliomas after treatment: a systematic review and meta-analysis

“…The remaining 28 studies met eligibility criteria for the systematic review. Seventeen studies evaluated DSC, [13][14][15]17,18,20,[23][24][25][27][28][29][30][31]34,36,39 8 evaluated DCE, 16,19,21,22,32,37,38,40 and 3 evaluated both DSC and DCE. 26,33,35 There were a total of 937 cases (54%) of tumor progression and 806 cases (46%) of treatment change.…”

“…Among DSC studies, 7 utilized contrast preloading, often in combination with postprocessing algorit hms, 20,[23][24][25][26]33,35 while 10 utilized only postprocessing techniques. 13,14,17,18,27,28,30,31,34,36 Six of the DCE studies used a model-free method, 19,22,26,32,33,37 4 used a 2-compartment model, 16,35,38,40 and 1 used both. 21 See Table 1 for an overview of study characteristics and Supplementary Table E1 for an overview of PWI protocols.…”

“…Five studies relied solely on clinical and/or radiological follow-up for confirmation of PWI findings without any histopathological confirmation. 30,35,36,38,40 Among the other 23 studies with at least one subject with histological follow-up, 14 provided some histological criteria for tumor…”

Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors

“…Advanced imaging techniques such as MR perfusion are used to complement structural imaging, providing further insight into tumor physiology. In adults, dynamic contrast-enhanced (DCE) MR perfusion has been used to determine tumor grade [3][4][5] and to distinguish pseudoprogression from tumor recurrence, 6 thus affecting treatment. While dynamic susceptibility contrast perfusion and DCE-MR perfusion in adult brain tumors have been extensively studied in the literature, particularly for monitoring tumor antiangiogenesis treatments, 7-11 DCE-MR imaging studies in pediatric brain tumors have been scarce [12][13][14][15][16][17][18] and have not focused on tumor grading.…”

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

“…For gliomas, PET and perfusion imaging are important for differentiation. For brain metastases, the data are limited, and progression is defined according to the RANO criteria for brain metastases [12,24,26,27,33,34]. In this study, recurrent tumor was proven histopathologically in 3 of 6 cases with local recurrence.…”