MR Imaging Analysis of Non-Measurable Enhancing Lesions Newly Appearing after Concomitant Chemoradiotherapy in Glioblastoma Patients for Prognosis Prediction

Abstract

PurposeTo analyze the enhancement patterns and apparent diffusion coefficient (ADC) values of non-measurable surgical cavity wall enhancement pattern, newly appearing after completion of standard concurrent chemoradiotherapy (CCRT) with temozolomide in glioblastoma patients for the prognosis prediction.Materials and MethodsFrom January 2010 to April 2014, among 190 patients with histopathologically confirmed glioblastoma, a total of 33 patients with non-measurable wall enhancement on post-CCRT MR imaging were enrolled and divided into two subgroups: non-progression (n = 18) and progression groups (n = 15). We analyzed the wall enhancement patterns, which were categorized into three patterns: thin, thick and nodular enhancement. ADC values were measured in the enhancing portions of the walls. The progression-free survival (PFS) related to the wall enhancement was analyzed by Kaplan-Meier analysis, and survival curves were compared using the log-rank test.ResultsStatistically significant differences in the surgical cavity wall enhancement patterns was shown between the progression and non-progression groups (P = 0.0032). Thin wall enhancement was more frequently observed in the non-progression group, and thick or nodular wall enhancement were observed in the progression group (P = 0.0016). There was no statistically significant difference in the mean ADC values between the progression and non-progression groups. The mean PFS was longer in patients with thin wall enhancement than in those with nodular or thick wall enhancement (35.5 months vs. 15.8 months, P = 0.008).ConclusionPattern analysis of non-measurable surgical cavity wall enhancement on post-CCRT MR imaging might be useful tool for predicting prognosis of GBM patient before clear progression of non-measurable disease.

Impact of Relative T2-FLAIR Signal Intensity of Non-Enhancing Lesions Outside Residual Cavity in Early Follow-up MRI on Outcome of Lower Grade Gliomas

“…This phenomenon may be explained by the gliomas enrolled with lower grade in this study. The above mentioned MRI features could be detected more often in those post-treatment glioblastoma patients [12,13]. The incidences of thick-linear and nodular enhancement (34.87%), new distal enhancement (5.26%), new SVZ involvement (20.39%) were lower than those of glioma (51.52%, 25.43%, and 49.14% separately) [12,13].…”

“…The conventional MR features analyzed included: the enhancement pattern of the residual cavity wall, new distal enhancement disease, new involvement of subventricular zone (SVZ). The enhancement of the residual cavity wall was categorized into three types: no enhancement; thinlinear enhancement (partial or entire wall enhancement with thickness < 3 mm), thick-linear (partial or entire wall enhancement of 3 ~ 5mm thickness) or nodular (5 ~ 10mm in thickness) enhancement [12]. New distal parenchymal enhancement was de ned as new enhanced disease that not contiguous (> 1.5 cm away from) with residual cavity or remnants of tumor after resection [13].…”

Perfusion of surgical cavity wall enhancement in early post-treatment MR imaging may stratify the time-to-progression in glioblastoma

“…Previous studies using postoperative MR imaging have reported that thick or nodular enhancement patterns had a poorer prognosis than thin enhancements, according to a thickness criterion of 5 mm [2–4]. In addition, a recent study by Kim et al [28] of newly developed non-measurable enhancing lesions after CCRT reported a similar result, namely that the progression group showed frequent thick (≥ 3 mm) or nodular (≥ 5 mm) enhancements. Our current study differs from those of previous studies however because only thick wall enhancement (≥ 5 mm) was included in our present analysis to assess the significance of perfusion at SCWEs.…”

Role of Dynamic Susceptibility Contrast Perfusion MRI in Glioma Progression Evaluation

“…The imaging analysis and postprocessing were performed on a workstation (PHILIPS Extended MR WorkSpace 2.6.3.4). The enhancement patterns of residual cavity wall were divided into thin-linear (partial or entire wall enhancement with thickness <3 mm), thick-linear (partial or entire wall enhancement of 3–5 mm in thickness), and nodular wall enhancement (with nodular enhancement of 5–10 mm in thickness) patterns [ 14 ]. Cerebral blood volume (CBV) was calculated based on signal intensity-time curves in transverse T 2 ∗ -weighted sequence.…”