Multimodal MRI-Based Radiomic Nomogram for the Early Differentiation of Recurrence and Pseudoprogression of High-Grade Glioma

Abstract

Objective. To evaluate the diagnostic value of multimodal MRI radiomics based on T2-weighted fluid attenuated inversion recovery imaging (T2WI-FLAIR) combined with T1-weighted contrast enhanced imaging (T1WI-CE) in the early differentiation of high-grade glioma recurrence from pseudoprogression. Methods. A total of one hundred eighteen patients with brain gliomas who were diagnosed from March 2014 to April 2020 were retrospectively analyzed. According to the clinical characteristics, the patients were randomly split into a training group ( n = 83 ) and a test group ( n = 35 ) at a 7 : 3 ratio. The region of interest (ROI) was delineated, and 2632 radiomic features were extracted. We used multiple logistic regression to establish a classification model, including the T 1 model, T 2 model, and T 1 + T 2 model, to differentiate recurrence from pseudoprogression. The diagnostic efficiency of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and accuracy (ACC) and by analyzing the calibration curve of the nomogram and decision curve. Results. There were 75 cases of recurrence and 43 cases of pseudoprogression. The diagnostic efficacies of the multimodal MRI-based radiomic model were relatively high. The AUC values and ACC of the training group were 0.831 and 77.11%, respectively, and the AUC values and ACC of the test group were 0.829 and 88.57%, respectively. The calibration curve of the nomogram showed that the discrimination probability was consistent with the actual occurrence in the training group, and the discrimination probability was roughly the same as the actual occurrence in the test group. In the decision curve analysis, the T 1 + T 2 model showed greater overall net efficiency. Conclusion. The multimodal MRI radiomic model has relatively high efficiency in the early differentiation of recurrence from pseudoprogression, and it could be helpful for clinicians in devising correct treatment plans so that patients can be treated in a timely and accurate manner.

Multimodal MRI-based radiomic nomogram for predicting telomerase reverse transcriptase promoter mutation in IDH-wildtype histological lower-grade gliomas

“…Recent studies have demonstrated the usefulness of radiomics in predicting molecular subgroups of glioma, such as IDH mutations, [6,18] TP53, [19] and MGMT promoter methylations, [20] as well as the recurrence and pseudo progression of high-grade glioma. [21] And, many studies have shown that IDHwt LGAs with TERTp-mutant status have been shown to have a poor prognosis compared to TERTp-wildtype patients and the presence alone is sufficient for the diagnosis of glioblastoma, IDH wt. [4,[22][23][24] However, prediction of TERTp-mutation before surgery and molecular testing can be challenging, as the image features on CT and MRI scans or the pathologically features may appear similar.…”

A Rapid Late Enhancement MRI Protocol Improves Differentiation between Brain Tumor Recurrence and Treatment-Related Contrast Enhancement of Brain Parenchyma

“…Regarding radiomics, Jing et al were able to differentiate early tumor recurrence from pseudo progression when analyzing 2632 radiomic features (e.g., shape features and intensity) in 118 patients. Their method reached a sensitivity and specificity between 64% and 86% and between 61% and 86%, respectively, in discrimination suspect from post-therapeutic lesions (or TRCE) [ 11 ]. Perfusion-weighted sequences, such as the DSC and DCE, are most widely used as a diagnostic tool for everyday clinical use [ 25 ].…”

“…One of these tumor mimics is radiation necrosis, observed several months and up to years after radiation therapy, is defined by delayed irreversible damage to blood vessels, leading to ischemic necrosis, demyelination, and hemorrhage [ 9 ]. Pseudo progression is a combination of regional inflammation-associated edema and increased vessel permeability without tumoral cell growth, usually frequently occurring within a few months after the end of radiation therapy [ 10 , 11 ]. As both processes show contrast enhancement within the treatment region, it can be difficult to distinguish therapy-related contrast enhancement of brain parenchyma from tumor recurrence or tumor progression.…”

Retracted: Multimodal MRI‐Based Radiomic Nomogram for the Early Differentiation of Recurrence and Pseudoprogression of High‐Grade Glioma

“…This article has been retracted by Hindawi, as publisher, following an investigation undertaken by the publisher [1]. This investigation has uncovered evidence of systematic manipulation of the publication and peer-review process.…”