Analysis of heterogeneity in T2-weighted MR images can differentiate pseudoprogression from progression in glioblastoma

Booth, Thomas C.; Larkin, Timothy J.; Yuan, Yinyin; Kettunen, Mikko I.; Dawson, Sarah; Scoffings, Daniel; Canuto, Holly C.; Vowler, Sarah L.; Kirschenlohr, Heide L.; Hobson, M.; Markowetz, Florian; Jefferies, Sarah; Brindle, Kevin M.

doi:10.1371/journal.pone.0176528

Cited by 38 publications

(51 citation statements)

References 73 publications

(96 reference statements)

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“…GLCM was also trialed for T 1 ‐weighted, T 2 ‐weighted, and T 2 ‐fluid‐attenuated inversion recovery (FLAIR) MRI, achieving an accuracy of 86% for the differentiation of glioblastoma from pseudoprogression . Booth et al distinguished pseudoprogression from true PD with >85% accuracy using descriptors of image heterogeneity called Minkowski functionals, further highlighting the potential value of anatomical MRI texture analysis . Learning methods can be adapted to permit more or less liberal classifications, depending on whether sensitivity or specificity is most desirable …”

Section: Novel Methodsmentioning

confidence: 99%

Pseudoprogression of brain tumors

Thust

Bent

Smits

2018

Magnetic Resonance Imaging

227

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This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high‐grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day‐to‐day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9–30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow‐up. The combination of MRS and diffusion‐weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer‐aided diagnostic technology, and meticulous evaluation with clinical and pathological data. Level of Evidence: 3 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;48:571–589.

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Section: Novel Methodsmentioning

confidence: 99%

Pseudoprogression of brain tumors

Thust

Bent

Smits

2018

Magnetic Resonance Imaging

227

194

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“…64,65 Radiomics has already demonstrated its prognostic value in differentiating pseudoprogression from tumor progression based on textural features of conventional MRI. [66][67][68] Studies including perfusion parameters in radiomics analyses for treatment evaluation in GBM are currently scarce, but preliminary data are promising. 69 Radiomic-derived features can also be combined with molecular and genetic data (radiogenomics).…”

Section: New Mri Perfusion Techniquesmentioning

confidence: 99%

Perfusion MRI in treatment evaluation of glioblastomas: Clinical relevance of current and future techniques

Dijken

Laar

Smits

et al. 2018

Magnetic Resonance Imaging

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Treatment evaluation of patients with glioblastomas is important to aid in clinical decisions. Conventional MRI with contrast is currently the standard method, but unable to differentiate tumor progression from treatment‐related effects. Pseudoprogression appears as new enhancement, and thus mimics tumor progression on conventional MRI. Contrarily, a decrease in enhancement or edema on conventional MRI during antiangiogenic treatment can be due to pseudoresponse and is not necessarily reflective of a favorable outcome. Neovascularization is a hallmark of tumor progression but not for posttherapeutic effects. Perfusion‐weighted MRI provides a plethora of additional parameters that can help to identify this neovascularization. This review shows that perfusion MRI aids to identify tumor progression, pseudoprogression, and pseudoresponse. The review provides an overview of the most applicable perfusion MRI methods and their limitations. Finally, future developments and remaining challenges of perfusion MRI in treatment evaluation in neuro‐oncology are discussed. Level of Evidence: 3 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2019;49:11–22.

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“…Pseudoprogression and radiation necrosis are two welldocumented forms of PTRE. Pseudoprogression generally occurs within the six months following completion of chemoradiotherapy, and resolves or stabilises without additional treatment [15,[17][18][19]60], whereas radiation necrosis generally occurs beyond 6 months, up to several years after radiotherapy, and is often more severe and progressive [15,19]. Structural imaging alone cannot reliably discriminate between true progression and PTRE, due to the common features of contrast enhancement, perilesional oedema-like appearance and mass effect.…”

Section: Comparison With Other Studies and Study Relevancementioning

confidence: 99%

“…The precise pathophysiological mechanism is still poorly understood, but histologic features typically associated with treatment effects such as bland necrosis with prominent vascular fibrinoid necrosis, reactive gliosis, oedema, demyelination and vascular hyalinisation are seen in those with pseudoprogression [16]. Pseudoprogression appears within 6 months of radiotherapy completion [17,18], which is earlier than radiation necrosis [15,19], another post-treatment-related effect (PTRE). Pseudoprogression appears to be more frequent in patients with a methylated MGMT gene promoter [15,20].…”

Section: Introductionmentioning

confidence: 99%

Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study)

et al. 2020

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Objectives MRI remains the preferred imaging investigation for glioblastoma. Appropriate and timely neuroimaging in the follow-up period is considered to be important in making management decisions. There is a paucity of evidence-based information in current UK, European and international guidelines regarding the optimal timing and type of neuroimaging following initial neurosurgical treatment. This study assessed the current imaging practices amongst UK neuro-oncology centres, thus providing baseline data and informing future practice. Methods The lead neuro-oncologist, neuroradiologist and neurosurgeon from every UK neuro-oncology centre were invited to complete an online survey. Participants were asked about current and ideal imaging practices following initial treatment. Results Ninety-two participants from all 31 neuro-oncology centres completed the survey (100% response rate). Most centres routinely performed an early post-operative MRI (87%, 27/31), whereas only a third performed a pre-radiotherapy MRI (32%, 10/31). The number and timing of scans routinely performed during adjuvant TMZ treatment varied widely between centres. At the end of the adjuvant period, most centres performed an MRI (71%, 22/31), followed by monitoring scans at 3 monthly intervals (81%, 25/31). Additional short-interval imaging was carried out in cases of possible pseudoprogression in most centres (71%, 22/31). Routine use of advanced imaging was infrequent; however, the addition of advanced sequences was the most popular suggestion for ideal imaging practice, followed by changes in the timing of EPMRI. Conclusion Variations in neuroimaging practices exist after initial glioblastoma treatment within the UK. Multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment. Key Points • Variations in imaging practices exist in the frequency, timing and type of interval neuroimaging after initial treatment of glioblastoma within the UK. • Large, multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment.

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Analysis of heterogeneity in T2-weighted MR images can differentiate pseudoprogression from progression in glioblastoma

Cited by 38 publications

References 73 publications

Pseudoprogression of brain tumors

Pseudoprogression of brain tumors

Perfusion MRI in treatment evaluation of glioblastomas: Clinical relevance of current and future techniques

Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study)

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