Magnetic resonance (MR) perfusion imaging to differentiate early progression from pseudoprogression following chemoradiotherapy for glioblastoma (GBM).

Graber, Jerome; Young, Robert J.; Gupta, Abhinav; Shah, Aastha; Chan, Timothy A.; Zhang, Z.; Shi, Wenwei; Beal, K.; Omuro, Antonio

doi:10.1200/jco.2011.29.15_suppl.2009

Cited by 4 publications

(6 citation statements)

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“…A cutoff value for the rCBV ratio was determined, which allowed for 81.5% sensitivity and 77.8% specificity in determining PsP from ePD. Another group similarly showed that patients with PsP had lower median rCBV values compared with ePD; one rCBV threshold detected PsP with 100% sensitivity and 75% specificity, while another threshold achieved 100% specificity to detect PsP, but only 69% specificity [60]. These studies highlight the potential for DSC MR perfusion to differentiate PsP from ePD.…”

Section: Strengths Limitationsmentioning

confidence: 77%

“…Can characterize tissues and pathologic processes at the microscopic level ADC depends on sampling method -confounded by necrosis, vascularity MR perfusion [38,43,[53][54][55][56][57][58][59][60][61][62] Higher rCBV in areas of enhancement Studies have correlated rCBV values to tissueconfirmed diagnoses [53] and survival [59] Vascular leak problematic, requires correction; rCBV value cutoffs vary by technique, institution…”

Section: Strengths Limitationsmentioning

confidence: 99%

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Pseudoprogression after glioma therapy: a comprehensive review

Kruser

Mehta

Robins

2013

Expert Review of Neurotherapeutics

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Over the last decade, pseudoprogression as a clinically significant entity affecting both glioma patient management and the conduct of clinical trials has been recognized as a significant issue. The authors have summarized the literature relative to the incidence, chronological sequence, therapy-relatedness, impact of O-6-methylguanine-DNA methyltransferase methylation status and clinical features of pseudoprogression. Evidence regarding numerous neuroradiologic techniques to differentiate pseudoprogression from tumor recurrence is summarized. The implications of pseudoprogression on prognosis and clinical trial design are substantial, and are reviewed. Relative to this, the overlapping terms pseudoprogression and radiation necrosis are clarified to produce an appropriate basis for future consideration and research regarding this important biological phenomenon.

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Section: Strengths Limitationsmentioning

confidence: 77%

Section: Strengths Limitationsmentioning

confidence: 99%

Pseudoprogression after glioma therapy: a comprehensive review

Kruser

Mehta

Robins

2013

Expert Review of Neurotherapeutics

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“…According to study of Bobek-Billewicz et al, rCBV was greater than 1.7 in recurrent tumor and less than 1.0 in post therapeutic changes (25). Different cut-off values of rCBV are reported in different studies between 1.47 and 2.12 to detect pseudoprogression (26)(27)(28). In the present study, rCBV values of three cases with pseudoprogression after RT-TMZ treatment were measured as 2.6, 1.9 and 1.6, respectively, which were relatively high compared to literature.…”

Section: Discussionmentioning

confidence: 99%

Distinction of Pseudoprogression and Progression in Glioblastoma Multiforme After Treatment: Utility of Ratio of Decrease in rCBV and rCBF Values on Serial Perfusion MRIs

ŞAHİN

ÇALLI

2023

İzmir Tıp Fakültesi Dergisi

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Aim: To assess the value of perfusion magnetic resonance imaging (pMRI) in the differentiation of early pseudoprogression from true progression in glioblastoma multiforme (GBM) patients taking Temozolomide (TMZ) with radiotherapy (RT) treatment. Materials and Methods: Pre-RT and post-RT cranial pMRI scans of 23 GBM patients treated with RT-TMZ were reviewed. Relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) of the residual enhancing lesions were measured on serial pMRI scans and proportioned. ROC analysis was performed to determine a threshold ratio of decrease in rCBV and rCBF. Results: There were nine patients (39%) with signs of radiological progression, of whom six (67%) had real progression and three (33%) had pseudoprogression based on follow-up MRI studies, clinical parameters and/or pathology. Ratio of decrease was 2.928 in rCBV and 2.510 in rCBF in the pseudoprogression group, which were significant according to Mann-Whitney U test (p=0.02). Cut-off ratio of decrease value of 1.73 for rCBV and 1.62 for rCBF between pre-RT and post-RT pMRI study, could differentiate the presence of early pseudoprogression with 100% sensitivity and 100% specificity. Conclusion: Ratio of decrease in rCBV and rCBF is a reliable predictor of early pseudoprogression in GBM patients under RT-TMZ treatment.

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“…These two techniques provide information on absolute blood flow, blood volume, and relative blood volume, which can then be a biomarker for tumor progression over time, as GBMs are highly vascular tumors associated with increased blood volume and blood flow. 57 Furthermore, although many studies achieve significantly different rCBVs between tumor tissue and pseudoprogression, the thresholds selected vary greatly and range from 0.7 to 2.4. Hu et al published a prospective study of 13 patients with high-grade gliomas with contrast-enhancing lesions on follow-up scans.…”

Section: Perfusion Imagingmentioning

confidence: 99%

“…This technique was first used in 2009 to differentiate tumor progression from radiation effects and pseudoprogression. 49,57 Therefore, the optimal threshold has yet to be determined and validated for widespread clinical use. 49 Three-tesla gradient-echo DSC as well as contrastenhanced T1-weighted images were performed preoperatively.…”

Section: Perfusion Imagingmentioning

confidence: 99%