Pseudoprogression in Patients with Glioblastoma: Assessment by Using Volume-weighted Voxel-based Multiparametric Clustering of MR Imaging Data in an Independent Test Set

Abstract

VVMC is a superior and more reproducible imaging biomarker than single-parameter measurements for differentiating between pseudoprogression and ETP in patients with glioblastoma. Online supplemental material is available for this article.

MR perfusion-weighted imaging in the evaluation of high-grade gliomas after treatment: a systematic review and meta-analysis

“…Seventeen studies evaluated DSC, [13][14][15]17,18,20,[23][24][25][27][28][29][30][31]34,36,39 8 evaluated DCE, 16,19,21,22,32,37,38,40 and 3 evaluated both DSC and DCE. 26,33,35 There were a total of 937 cases (54%) of tumor progression and 806 cases (46%) of treatment change. Investigators reported that pseudoprogression was the specific treatment effect under evaluation in 13 studies, 14,17,18,[29][30][31]33,34,[36][37][38][39][40] radiation necrosis in 4 studies, 15,16,19,21 and both in 2 studies.…”

“…26,33,35 There were a total of 937 cases (54%) of tumor progression and 806 cases (46%) of treatment change. Investigators reported that pseudoprogression was the specific treatment effect under evaluation in 13 studies, 14,17,18,[29][30][31]33,34,[36][37][38][39][40] radiation necrosis in 4 studies, 15,16,19,21 and both in 2 studies. 25,34 Patients meeting inclusion criteria for pseudoprogression developed a new lesion during concurrent radiation and chemotherapy 29 out to 6 months after treatment completion.…”

“…39 Seven different types of PWI processing software were utilized, not including in-house software in several studies. Among DSC studies, 7 utilized contrast preloading, often in combination with postprocessing algorit hms, 20,[23][24][25][26]33,35 while 10 utilized only postprocessing techniques. 13,14,17,18,27,28,30,31,34,36 Six of the DCE studies used a model-free method, 19,22,26,32,33,37 4 used a 2-compartment model, 16,35,38,40 and 1 used both.…”

“…Patients on potentially confounding anti-angiogenic drugs or steroids were not excluded in at least 10 studies. 19,22,25,26,28,31,33,34,37,40 Neuroradiologists were often blinded to the outcome at the time of PWI analysis, but most studies did not report whether the pathologist was blinded to the imaging results. Five studies relied solely on clinical and/or radiological follow-up for confirmation of PWI findings without any histopathological confirmation.…”

High-Grade Glioma Management and Response Assessment—Recent Advances and Current Challenges

“…Dynamic contrast-enhanced mri parameters have been particularly useful in conjunction with parameters derived from dsc-mri. Multiparametric analysis from both dsc-mri and dynamic contrast-enhanced mri was used in a study of 108 patients, successfully discriminating pseudoprogression from true progression with a sensitivity of 87% and a specificity of 87.1%-90.3% 56 .…”