The Use of MR Perfusion Imaging in the Evaluation of Tumor Progression in Gliomas

Abstract

ObjectiveDiagnosing tumor progression and pseudoprogression remains challenging for many clinicians. Accurate recognition of these findings remains paramount given necessity of prompt treatment. However, no consensus has been reached on the optimal technique to discriminate tumor progression. We sought to investigate the role of magnetic resonance perfusion (MRP) to evaluate tumor progression in glioma patients.MethodsAn institutional retrospective review of glioma patients undergoing MRP with concurrent clinical follow up visit was performed. MRP was evaluated in its ability to predict tumor progression, defined clinically or radiographically, at concurrent clinical visit and at follow up visit. The data was then analyzed based on glioma grade and subtype.ResustsA total of 337 scans and associated clinical visits were reviewed from 64 patients. Sensitivity, specificity, positive and negative predictive value were reported for each tumor subtype and grade. The sensitivity and specificity for high-grade glioma were 60.8% and 87.8% respectively, compared to low-grade glioma which were 85.7% and 89.0% respectively. The value of MRP to assess future tumor progression within 90 days was 46.9% (sensitivity) and 85.0% (specificity).ConclusionBased on our retrospective review, we concluded that adjunct imaging modalities such as MRP are necessary to help diagnose clinical disease progression. However, there is no clear role for stand-alone surveillance MRP imaging in glioma patients especially to predict future tumor progression. It is best used as an adjunctive measure in patients in whom progression is suspected either clinically or radiographically.

Pseudoprogression as an adverse event of glioblastoma therapy

“…PsP is more frequent in patients treated with concomitant temozolomide than in those receiving radiation therapy alone and is particularly frequent in patients with O6‐methylguanine‐DNA methyltransferase ( MGMT ) promoter methylation (MGMT_MET) . In spite of new and promising advanced MRI and PET‐based techniques , PsP remains indistinguishable from early progression (eP). Since a final diagnosis can only be reached through histopathological verification or subsequent MRIs, PsP can confound treatment monitoring, with direct consequences in clinical practice, as it can lead to prematurely withholding adjuvant temozolomide or to overestimating the efficacy of a second‐line therapy.…”

Magnetic Resonance Perfusion Imaging in the Diagnosis of High-Grade Glioma Progression and Treatment-Related Changes: A Systematic Review

“…Ozsunar et al obtained similar sensitivity and specificity of 86% and 70% respectively, though they did manage to reach significance in their results (p < 0.01) [31]. A more recent publication by Snelling et al [36] in turn found a sensitivity of 60.8% and specificity of 87.8% using a purely qualitative method. and 12 for each of these parameters respectively.…”

“…Two publications looked at parameters from the SI-time curve including relative peak height (rPH) and percentage signal recovery (rPSR) [16] [39]. There were 3 studies that performed qualitative analysis using maps obtained from DSC-MRI [19] [31] [36].…”

Arterial spin labeling in the grading of brain gliomas: could it help?

“…The vascular pathology of low-grade glioma states that tumor vessels are mainly formed of normal endothelial cells, with cell-to-cell tight junction and relatively intact blood-brain barrier resulting in decreased blood flow and blood volume parameters in perfusion MRI techniques [3]. Most of the previous studies differentiating high-grade glioma from low-grade glioma by perfusion MRI techniques revealed low perfusion parameters in low-grade glioma patients [15,16]. In our study, 9 out of 14 low-grade glioma patients showed hypoperfusion in ASL-CBF comparable to DSC-PI, while four cases showed hyperperfusion on ASL, three of which were hypoperfused on DSC-PI.…”