The Value of Dynamic Contrast‐Enhanced Magnetic Resonance Imaging (DCE‐MRI) in the Differentiation of Pseudoprogression and Recurrence of Intracranial Gliomas

Abstract

Objective. The objective of this study was to determine the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing postoperative changes in intracranial gliomas. Method. A total of fifty-one patients who had new enhanced lesions after surgical resection followed by standard radiotherapy and chemotherapy were collected retrospectively from October 2014 to June 2021. The patients were divided into a pseudoprogression group (15 cases) and a recurrence group (36 cases) according to the pathological results of the second operation or a follow-up of more than six months. The follow-up data of all patients were complete, and DCE-MRI was performed. The images were processed to obtain the quantitative parameters Ktrans, Ve, and Kep and the semiquantitative parameter iAUC, which were analysed with relevant statistical software. Results. First, the difference in Ktrans and iAUC values between the two groups was statistically significant ( P < 0.05), and the difference in Ve and Kep values was not statistically significant ( P > 0.05). Second, by comparing the area under the curve, threshold, sensitivity and specificity of Ktrans, and iAUC, it was found that the iAUC threshold value was slightly higher than that of Ktrans, and the specificity of Ktrans was equal to that of iAUC, while the area under the curve and sensitivity of Ktrans were higher than those of iAUC. Third, Ktrans and iAUC had high accuracy in diagnosing recurrence and pseudoprogression, and Ktrans had higher accuracy than iAUC. Conclusion. In this study, DCE-MRI has a certain diagnostic value in the early differentiation of recurrence and pseudoprogression, offering a new method for the diagnosis and assessment of gliomas after surgery.

Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging in Differentiation Between Recurrence and Pseudoprogression in High-Grade Glioma: A Meta-analysis

“…2A, B). Of the included articles, 14 failed to disclose whether patients were consecutively enrolled, 11,14,16–18,20–24,26–29 and 13 did not discuss whether readers were blinded to final patient diagnoses when evaluating MRI results 11,12,14,16–18,20,22,24,26–28,30 …”

“…Nine and 12 of the included studies were conducted in Asia and Europe/America, respectively. World Health Organization grade 3 to 4 patients were enrolled in 9 of these studies, 17,20,22,[25][26][27][28][29]31 whereas the remaining 12 only enrolled WHO grade 4 patients. [11][12][13][14][15][16]18,19,21,23,24,30 Pathological diagnosis served as the reference standard in just one of the included studies, 29 with follow-up or pathological results serving as the reference in all other cases.…”

“…[11][12][13][14][15][16]18,19,21,23,24,30 Pathological diagnosis served as the reference standard in just one of the included studies, 29 with follow-up or pathological results serving as the reference in all other cases. Cerebral blood volume (CBV) was the diagnostic tool in 15 studies, [11][12][13][14]16,17,19,21,22,[24][25][26][29][30][31] whereas cerebral blood flow (CBF) was the diagnostic tool in 1 study, 20 and both CBV and CBF were used in 5 studies. 15,18,23,27,28 True-positive, falsepositive, true-negative, and false-negative results for each of the included studies are compiled in Table 2.…”

“…Cerebral blood flow-related diagnostic results were reported in 6 of the included studies, 15,18,20,23,27,28 with respective pooled sensitivity, specificity, PLR, and NLR values of 85% (95% CI, 0.78-0.90; Fig. 4A), 85% (95% CI, 0.76-0.91; Fig.…”

“…Some of these MRI techniques have been leveraged in an effort to more reliably distinguish between cases of PsP and RT 9,10 . Perfusion-weighted imaging, in particular, holds great promise in this diagnostic context given that it offers insight into parameters including blood perfusion, microvascular proliferation, and microcirculatory distribution characteristics in a given patient 11–31 . Recently published meta-analyses have explored the utility of PWI as a diagnostic tool capable of differentiating between PsP and RT in patients diagnosed with glioma 1–3 ; further research is vital to clarify the diagnostic utility of this approach in patients with high-grade glioma (HGG).…”