Longitudinal DSC-MRI for Distinguishing Tumor Recurrence From Pseudoprogression in Patients With a High-grade Glioma

Boxerman, Jerrold L.; Ellingson, Benjamin M.; Jeyapalan, Suriya; Elinzano, Heinrich; Harris, Robert J.; Rogg, Jeffrey; Pope, Whitney B.; Safran, Howard

doi:10.1097/coc.0000000000000156

Cited by 79 publications

(52 citation statements)

References 28 publications

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“…While the authors also used a volumetric approach, the lack of significance for histogram derived percentile metrics, and for VP, may have been due to their use of absolute values rather than normalized ratios that help mitigate inter-scanner and inter-patient variability. Similarly, in a study using DSC MRI to distinguish PD from PsP in high grade glioma, changes in relative cerebral blood volume (rCBV) over time were predictive, with PsP demonstrating an overall negative linear trend in rCBV and PD demonstrating a positive slope [19]. …”

Section: Discussionmentioning

confidence: 99%

Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

et al. 2015

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Pseudoprogression may present as transient new or increasing enhancing lesions that mimic recurrent tumors in treated glioblastoma. The purpose of this study was to examine the utility of dynamic contrast enhanced T1 magnetic resonance imaging (DCE MRI) in differentiating between pseudoprogression and tumor progression and devise a cut-off value sensitive for pseudoprogression. We retrospectively examined 37 patients with glioblastoma treated with radiation and temozolomide after surgical resection that then developed new or increasing enhancing lesion(s) indeterminate for pseudoprogression versus progression. Volumetric plasma volume (Vp) and time-dependent leakage constant (Ktrans) maps were measured for the enhancing lesion and the mean and ninetieth percentile histogram values recorded. Lesion outcome was determined by clinical follow up with pseudoprogression defined as stable disease not requiring new treatment. Statistical analysis was performed with Wilcoxon rank-sum tests. Patients with pseudoprogression (n = 13) had Vp (mean) = 2.4 and Vp (90 %tile) = 3.2; and Ktrans (mean) = 3.5 and Ktrans (90 %tile) = 4.2. Patients with tumor progression (n = 24) had Vp (mean) = 5.3 and Vp (90 %tile) = 6.6; and Ktrans (mean) = 7.4 and Ktrans (90 %tile) = 9.1. Compared with tumor progression, pseudoprogression demonstrated lower Vp perfusion values (p = 0.0002) with a Vp (mean) cutoff <3.7 yielding 85 % sensitivity and 79 % specificity for pseudoprogression. Ktrans (mean) of >3.6 had a 69 % sensitivity and 79 % specificity for disease progression. DCE MRI shows lower plasma volume and time dependent leakage constant values in pseudoprogression than in tumor progression. A cut-off value with high sensitivity for pseudoprogression can be applied to aid in interpretation of DCE MRI.

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Section: Discussionmentioning

confidence: 99%

Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

et al. 2015

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“…However, change in rCBV at first follow-up as well as the overall linear trend in rCBV was significantly different between the two groups. 36 …”

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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“…Due to the heightened angiogenic response in recurring gliomas, DSC-MRI derived CBV maps have been explored as a means to overcome this limitation (33–35). In a Phase II clinical trial of temozolomide, paclitaxel poliglumex, and concurrent radiation, the mean CBV measured at initial progressive enhancement and the change in CBV after therapy were used to distinguish PD and PsP (33). The single time point CBV values acquired after therapy were similar between patients exhibiting PsP and PD (2.35 vs. 2.17, p = 0.67).…”

Section: Quantitative Mri Techniques Currently Available For Clinimentioning

confidence: 99%

MR Imaging Biomarkers in Oncology Clinical Trials

Abramson

Arlinghaus

Dula

et al. 2016

Magnetic Resonance Imaging Clinics of North America

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Quantitative magnetic resonance imaging (MRI) techniques have the ability to quantitatively report various pathophysiological processes associated with cancer. These measures have been shown to provide complementary information to that typically obtained from standard morphologically based criteria (e.g., size) and, furthermore, have been shown to outperform sized based measures in certain applications. In this review, we discuss eight areas of quantitative MRI that are either currently employed in clinical trials, or are emerging as promising techniques for both diagnosing cancer as well as assessing—or even predicting—the response of cancer to various therapies. The currently employed methods include the response evaluation criteria in solid tumors (RECIST), dynamic susceptibility MRI (DSC-MRI), dynamic contrast enhanced MRI (DCE-MRI), and diffusion weighted imaging (DWI). The emerging techniques covered are chemical exchange saturation transfer MRI (CEST-MRI), elastography, hyperpolarized MRI, and multi-parameter MRI. After a brief introduction to each technique, we present a small number of illustrative applications before noting the existing limitations of each method and what must be done to move each to more routine clinical application.

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Longitudinal DSC-MRI for Distinguishing Tumor Recurrence From Pseudoprogression in Patients With a High-grade Glioma

Abstract: Longitudinal trends in rCBV may be more useful than absolute rCBV in distinguishing PsP from PD in chemoradiation-treated high-grade gliomas with DSC-MRI. Further studies of DSC-MRI in high-grade glioma as a potential technique for distinguishing PsP from PD are indicated.

Cited by 79 publications

References 28 publications

Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

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

MR Imaging Biomarkers in Oncology Clinical Trials

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