Differentiating Tumor Progression from Pseudoprogression in Patients with Glioblastomas Using Diffusion Tensor Imaging and Dynamic Susceptibility Contrast MRI

Wang, S.; Martinez‐Lage, Maria; Sakai, Yu; Chawla, Sanjeev; Kim, S.G.; Alonso‐Basanta, Michelle; Lustig, Robert A.; Brem, Steven; Mohan, Suyash; Wolf, Ronald L.; Desai, Arati; Poptani, Harish

doi:10.3174/ajnr.a4474

Cited by 126 publications

(121 citation statements)

References 32 publications

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“…In comparison to further studies that assessed the diagnostic potential for differentiation of PsP and PD, the results of the current study might be more promising than studies evaluating diffusion tensor imaging, dynamic susceptibility contrast and quantitative dynamic contrast-enhanced MRI [38,39]. On the other hand we received less promising results than recently published data by Galldiks et al for PET [40].…”

Section: Discussionmentioning

confidence: 60%

Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps

et al. 2017

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PurposeThe purpose of this study was to investigate whether a voxel-wise analysis of apparent diffusion coefficient (ADC) values may differentiate between progressive disease (PD) and pseudoprogression (PsP) in patients with high-grade glioma using the parametric response map, a newly introduced postprocessing tool.MethodsTwenty-eight patients with proven PD and seven patients with PsP were identified in this retrospective feasibility study. For all patients ADC baseline and follow-up maps on four subsequent MRIs were available. ADC maps were coregistered on contrast enhanced T1-weighted follow-up images. Subsequently, enhancement in the follow-up contrast enhanced T1-weighted image was manually delineated and a reference region of interest (ROI) was drawn in the contralateral white matter. Both ROIs were transferred to the ADC images. Relative ADC (rADC) (baseline)/reference ROI values and rADC (follow up)/reference ROI values were calculated for each voxel within the ROI. The corresponding voxels of rADC (follow up) and rADC (baseline) were subtracted and the percentage of all voxels within the ROI that exceeded the threshold of 0.25 was quantified.ResultsrADC voxels showed a decrease of 59.2% (1st quartile (Q1) 36.7; 3rd quartile (Q3) 78.6) above 0.25 in patients with PD and 18.6% (Q1 3.04; Q3 26.5) in patients with PsP (p = 0.005). Receiver operating characteristic curve analysis showed the optimal decreasing rADC cut-off value for identifying PD of > 27.05% (area under the curve 0.844±0.065, sensitivity 0.86, specificity 0.86, p = 0.014).ConclusionThis feasibility study shows that the assessment of rADC using parametric response maps might be a promising approach to contribute to the differentiation between PD and PsP. Further research in larger patient cohorts is necessary to finally determine its clinical utility.

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Section: Discussionmentioning

confidence: 60%

Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps

et al. 2017

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“…37 Thus the totality of the evidence indicates that DSCis fairly accurate in identifying true tumor progression. Achieving even greater accuracy may require combining DSC data with other advanced imaging modalities such as DTI, 38 ASL, 39 and MRS. 40, 41 This is not guaranteed, however; a recent meta-analysis of 9 studies found that monoparametric and multiparametric MRI performed equally in a clinical context. 42 Another caveat is that true versus pseudoprogression is a false dichotomy as oftentimes there is an intermixing of viable tumor and treatment effect with variable ratios of the two components.…”

Section: Clinical Applications Of Advanced Mrimentioning

confidence: 99%

“…Similarly investigations based on a combination of DSC and DTI data have also categorized tissue into true progression, mixed response, and pseudoprogression. 38 Such approaches may more accurately model post-treatment tumors.…”

Section: Clinical Applications Of Advanced Mrimentioning

confidence: 99%

Conventional and advanced magnetic resonance imaging in patients with high-grade glioma

Pope¹,

Brandal²

2018

Q J Nucl Med Mol Imaging

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Magnetic resonance imaging is integral to the care of patients with high-grade gliomas. Anatomic detail can be acquired with conventional structural imaging, but newer approaches also add capabilities to interrogate image-derived physiologic and molecular characteristics of central nervous system neoplasms. These advanced imaging techniques are increasingly employed to generate biomarkers that better reflect tumor burden and therapy response. The following is an overview of current strategies based on advanced magnetic resonance imaging that are used in the assessment of high-grade glioma patients with an emphasis on how novel imaging biomarkers can potentially advance patient care.

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“…For gliomas, PET and perfusion imaging are important for differentiation. For brain metastases, the data are limited, and progression is defined according to the RANO criteria for brain metastases [12,24,26,27,33,34]. In this study, recurrent tumor was proven histopathologically in 3 of 6 cases with local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

Bette

Gempt

Wiestler

et al. 2016

Fortschr Röntgenstr

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Results 3 of 6 cases with local tumor recurrence showed a FLAIR signal increase (sensitivity 50.0 %, specificity 100.0 %). In one case, this sign was observed even about 3 months before tumor recurrence.The specificity of FLAIR signal increase for overall tumor recurrence (local and distant) was also 100.0 %, but with a lower sensitivity of 13.0 %.Quantitative analysis showed significant differences for signal intensity of the resection cavity as well as for the change of signal intensity of the resection cavity in cases with or without local tumor recurrence.Conclusion An increase in FLAIR signal of the fluid within the resection cavity might be a highly specific and early sign of local tumor recurrence/tumor progression also for brain metastases. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.Key points: ▪ An increase in FLAIR signal intensity of the fluid within the resection cavity is also observed in previously resected brain metastases. ▪ The pathophysiology of this sign might be due to a cell-proliferative process.

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Differentiating Tumor Progression from Pseudoprogression in Patients with Glioblastomas Using Diffusion Tensor Imaging and Dynamic Susceptibility Contrast MRI

Abstract: BACKGROUND AND PURPOSE:Early assessment of treatment response is critical in patients with glioblastomas. A combination of DTI and DSC perfusion imaging parameters was evaluated to distinguish glioblastomas with true progression from mixed response and pseudoprogression.

Cited by 126 publications

References 32 publications

Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps

Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps

Conventional and advanced magnetic resonance imaging in patients with high-grade glioma

Increase in FLAIR Signal of the Fluid Within the Resection Cavity as Early Recurrence Marker: Also Valid for Brain Metastases?

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