Prospective comparative diagnostic accuracy evaluation of dynamic contrast‐enhanced (DCE) vs. dynamic susceptibility contrast (DSC) MR perfusion in differentiating tumor recurrence from radiation necrosis in treated high‐grade gliomas

Abstract

Background The appearance of a new enhancing lesion after surgery and chemoradiation for high‐grade glioma (HGG) presents a common diagnostic dilemma. Histopathological analysis remains the reference standard in this situation. Purpose To prospectively compare the diagnostic accuracy of dynamic contrast‐enhanced (DCE) vs. dynamic susceptibility contrast (DSC) in differentiating tumor recurrence (TR) from radiation necrosis (RN). Study Type Prospective diagnostic accuracy study. Population In all, 98 consecutive treated HGG patients with new enhancing lesion. We excluded 32 patients due to inadequate follow‐up or technical limitation. Field Strength/Sequence 3 T DCE and DSC MR. Assessment Histogram and hot‐spot analysis of cerebral blood volume (CBV), corrected CBV, Ktrans, area under the curve (AUC), and plasma volume (Vp). The reference standard of TR and/or RN was determined by histopathology in 43 surgically resected lesions or by clinical/imaging follow‐up in the rest. Statistical Tests Mann–Whitney U‐tests, receiver operating characteristic (ROC) curve, and logistic regression analysis. Results A total of 68 lesions were included. There were 37 TR, 28 RN, and three lesions with equal proportions of TR and RN. TR had significantly higher CBV, corrected CBV, CBV ratio, corrected CBV ratio, AUC ratio, and Vp ratio (P < 0.05) than RN on hot‐spot analysis. CBV had the highest diagnostic accuracy (AUROC 0.71). On histogram analysis, TR had higher CBV and corrected CBV maximal value compared with RN (P = 0.006, AUROC = 0.70). Only CBV on hot‐spot analysis remained significant after correction for multiple comparison, with no significant improvement in diagnostic accuracy when using a combination of parameters (AUROC 0.71 vs. 0.76, P = 0.24). Data Conclusion DSC‐derived CBV is the most accurate perfusion parameter in differentiating TR and RN. DSC and DCE‐derived parameters reflecting the blood volume in an enhancing lesion are more accurate than the DCE‐derived parameter Ktrans. Clinical practice may be best guided by blood volume measurements, rather than permeability assessment for differentiation of TR from RN. Level of Evidence: 1 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2019;50:573–582.

Intravoxel Incoherent Motion and Dynamic Contrast‐Enhanced Magnetic Resonance Imaging to Early Detect Tissue Injury and Microcirculation Alteration in Hepatic Injury Induced by Intestinal Ischemia–Reperfusion in a Rat Model

“…This study showed that the V e value gradually increased from the Sham group to the IR4h group, indicating an expansion of the EES volume. This phenomenon is considered to be mainly related to hepatocellular necrosis and vacuolization, as demonstrated by H&E examinations 27–29 . This study showed that the degrees of change in f and V e were higher than those of other imaging parameters at 2 hours (IR1h), which implied that perfusion plays a more important role in early hepatic injury induced by IIR.…”

Transformational Role of Medical Imaging in (Radiation) Oncology

“…A recent meta-analysis showed pooled sensitivities and specificities for detecting tumor recurrence in high-grade gliomas using the mean rCBV (threshold range, 0.9–2.15) and maximum rCBV (threshold range, 1.49–3.1) corresponding to 88% and 88% (95% CI: 0.81–0.94; 0.78–0.95) and 93% and 76% (95% CI: 0.86–0.98; 0.66–0.85), respectively [ 20 ]. In a head-to-head comparison between DCE and DSC for the differentiation between tumor recurrence and radiation necrosis in treated high grade gliomas, DSC perfusion showed higher diagnostic accuracy than DCE perfusion [ 24 ].…”

“…Therefore, the location of the low ADC values is key. Reduced ADC in the central necrosis suggests coagulative necrosis in the context of radiation necrosis whereas reduced ADC in the solid or enhancing lesion components suggests hyper-cellularity associated to recurrent tumor [ 24 ].…”

Brain MR findings in patients treated with particle therapy for skull base tumors

“…Because of the vascular pauperization in radiation injury lesions and consequently the small volume of gadolinium accumulating in extravascular space in affected brain areas, low K trans values are expected [57, 58] while higher K trans values are expected in tumor recurrence. However, the radiation-induced endothelial damage could lead to an increased capillary permeability in radiation necrosis with feedback of K trans values higher than expected [59].…”

“…In particular, in order to differentiate tumor recurrence and radiation necrosis in treated high-grade gliomas, Zakhari et al [59] reported that DSC-derived CBV measurement is more accurate compared with DCE-derived parameters including the permeability parameter ( K trans ). They also reported that a combination of T1 and T2 perfusion parameters showed no significant improvement in diagnostic accuracy compared with CBV.…”