Qualitative Assessment of Advanced MRI in Post-Treatment High Grade Gliomas Follow Up: Do We Agree?

Abstract

Purpose: MRI is commonly used in follow up of high grade glioma. Our purpose is to assess the interrater agreement on the increasingly used visual qualitative assessment of various conventional and advanced MR techniques in the setting of treated high grade glioma in comparison to the well established quantitative measurements. Methods: We prospectively enrolled HGG patients who underwent reresection of a new enhancing lesion on post-treatment 3T MR examination including DWI, DCE and DSC sequences. Two neuroradiologists objectively assessed the diffusion and perfusion maps by placing ROI on representative post-processed maps. They subjectively assessed the post-contrast, perfusion and diffusion sequences. Interrater agreement and concordance correlation coefficient were calculated. Results: Twenty-eight lesions were included. The interrater agreement on the qualitative assessment was good for k-trans (k = 0.73), moderate for Vp (k = 0.52), fair for AUC and Ve maps (k = 0.37 and 0.21), fair for corrected CBV (k = 0.39) and poor for the enhancement pattern and presence of diffusion restriction (k = 0.02 and 0.07). The concordance between the quantitative measurements was substantial for AUC and Vp (ρc = 0.98 and 0.97), moderate for k-trans and corrected CBV (ρc = 0.94) and poor for Ve and ADC (ρc = 0.86 and 0.24). Conclusion: While the quantitative measurements of DSC and DCE perfusion maps show satisfactory inter-rater agreement, the qualitative assessment has lower interobserver agreement and should not be relied upon solely in the interpretation. Similarly, the suboptimal inter-rater agreement on the interpretation of enhancement pattern and diffusion restriction potentially limits their usefulness in differentiating glioma recurrence from treatment related changes.

Hybrid18F-Fluoroethyltyrosine PET and MRI with Perfusion to Distinguish Disease Progression from Treatment-Related Change in Malignant Brain Tumors: The Quest to Beat the Toughest Cases

“…Importantly, when dynamic susceptibility contrast or dynamic contrast-enhanced MRI is suboptimal or nondiagnostic, 18 F-FET PET still supports high clinician diagnostic confidence because it resists PWI failure (36). Because interreader qualitative assessment varies with PWI alone (37), complementary imaging enables a more robust diagnostic outcome. Previous studies have advocated for sequential PWI and 18 F-FET PET in glioma evaluation due to a 100% reported positive predictive value for rCBV, but our reported 93% positive predictive value for rCBV did not exceed that of TBR mean or TBR max (96% and 97%, respectively) (38).…”

Advancements in Image-Based Models for High-Grade Gliomas Might Be Accelerated

“…Among patients without or with decreased post-radiotherapy necrosis, the median OS was 17.6 months and 18.1 months for patients that did and did not use bevacizumab, respectively (M). Relevant Kaplan-Meier plots are shown (after [44][45][46][47] with permission).…”

“…The concordance between different diagnosticians using visual qualitative assessments of MRI images, compared to the concordance of different quantitative perfusion measurements, was studied by Zakhari and colleagues (Figure 5E-G) (Table 1). While quantitative measurements of DSC and dynamic CE (DCE) perfusion maps showed satisfactory inter-rater agreements, qualitative assessment using only conventional MRI images had an inferior inter-observer agreement and was insufficient for a correct diagnostic interpretation [45]. L,M).…”