Potential for differentiation of pseudoprogression from true tumor progression with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging using ferumoxytol vs. gadoteridol: a pilot study.
OBJECTIVE
We evaluated dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI) using gadoteridol in comparison to the iron oxide nanoparticle blood pool agent, ferumoxytol, in patients with glioblastoma multiforme (GBM) who received standard radiochemotherapy (RCT).


METHODS
Fourteen patients with GBM received standard RCT and underwent 19 MRI sessions that included DSC-MRI acquisitions with gadoteridol on Day 1 and ferumoxytol on Day 2. Relative cerebral blood volume (rCBV) values were calculated from DSC data obtained from each contrast agent. T1-weighted acquisition post-gadoteridol administration was used to identify enhancing regions.


RESULTS
In seven MRI sessions of clinically presumptive active tumor, gadoteridol-DSC showed low rCBV in three and high rCBV in four, whereas ferumoxytol-DSC showed high rCBV in all seven sessions (p = 0.002). After RCT, seven MRI sessions showed increased gadoteridol contrast enhancement on T1-weighted scans coupled with low rCBV without significant differences between contrast agents (p = 0.9). Based on post-gadoteridol T1-weighted scans, DSC-MRI, and clinical presentation, four patterns of response to RCT were observed: regression, pseudoprogression, true progression, and mixed response.


CONCLUSIONS
We conclude that DSC-MRI with a blood pool agent such as ferumoxytol may provide a better monitor of tumor rCBV than DSC-MRI with gadoteridol. Lesions demonstrating increased enhancement on T1-weighted MRI coupled with low ferumoxytol rCBV are likely exhibiting pseudoprogression, whereas high rCBV with ferumoxytol is a better marker than gadoteridol for determining active tumor. These interesting pilot observations suggest that ferumoxytol may differentiate tumor progression from pseudoprogression and warrant further investigation.
Gahramanov
Seymur
S
Department of Neurology, Oregon Health and Science University, Portland, OR 97239-3098, USA.
Raslan
Ahmed M
AM
Muldoon
Leslie L
LL
Hamilton
Bronwyn E
BE
Rooney
William D
WD
Varallyay
Csanad G
CG
Njus
Jeffrey M
JM
Haluska
Marianne
M
Neuwelt
Edward A
EA
D000328:Adult; D000368:Aged; D001810:Blood Volume; D001812:Blood-Brain Barrier; D001932:Brain Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D052203:Ferrosoferric Oxide; D005682:Gadolinium; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D055815:Young Adult
D003287:Contrast Media; D006571:Heterocyclic Compounds; D058185:Magnetite Nanoparticles; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D052203:Ferrosoferric Oxide
Lancet Oncol. 2008 May;9(5):453-61
18452856
J Clin Oncol. 2006 Mar 10;24(8):1228-35
16525177
J Magn Reson Imaging. 2004 May;19(5):546-54
15112303
AJNR Am J Neuroradiol. 2004 Feb;25(2):214-21
14970020
Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):876-85
16298499
Radiology. 1994 Apr;191(1):41-51
8134596
Neuroradiology. 2002 Mar;44(3):216-22
11942375
Radiology. 2008 Apr;247(1):170-8
18372467
Ann Surg Oncol. 2007 Jun;14(6):1860-9
17356952
Radiology. 2009 Nov;253(2):486-96
19789240
Ann Nucl Med. 2004 Jun;18(4):291-6
15359921
Neurosurgery. 2007 Apr;60(4):601-11; discussion 611-2
17415196
Surg Neurol. 2009 Oct;72(4):423-8
19150114
J Neurol. 2009 Jun;256(6):878-87
19274425
Radiology. 1999 Jun;211(3):791-8
10352608
N Engl J Med. 2005 Mar 10;352(10):987-96
15758009
Neurosurgery. 2005 Sep;57(3):505-11; discussion 505-11
16145529
Radiat Res. 2000 Apr;153(4):357-70
10798963
Mol Interv. 2004 Oct;4(5):273-84
15471910
Radiology. 2008 Nov;249(2):601-13
18780827
Neuro Oncol. 2008 Jun;10(3):361-7
18401015
AJR Am J Roentgenol. 1998 Dec;171(6):1479-86
9843274
Clin Cancer Res. 2004 May 15;10(10):3342-53
15161688
J Neurooncol. 2007 Mar;82(1):81-3
16944309
J Cereb Blood Flow Metab. 2010 Jan;30(1):15-35
19756021
AJNR Am J Neuroradiol. 2009 Mar;30(3):552-8
19056837
Radiology. 2008 May;247(2):490-8
18349315
Radiology. 2008 Nov;249(2):416-7
18936306
J Clin Oncol. 2008 May 1;26(13):2192-7
18445844
AJNR Am J Neuroradiol. 2001 Aug;22(7):1316-24
11498420
J Cereb Blood Flow Metab. 2009 Apr;29(4):853-60
19142191