title: Differentiation of tumor progression from pseudoprogression in patients with posttreatment glioblastoma using multiparametric histogram analysis.
abstract: OBJECTIVE
  The multiparametric imaging can show us different aspects of tumor behavior and may help differentiation of tumor recurrence from treatment related change. Our aim was to differentiate tumor progression from pseudoprogression in patients with glioblastoma by using multiparametric histogram analysis of 2 consecutive MR imaging studies with relative cerebral blood volume and ADC values.
  
  
  METHODS
  Thirty-five consecutive patients with glioblastoma with new or increased size of enhancing lesions after concomitant chemoradiation therapy following surgical resection were included. Combined histograms were made by using the relative cerebral blood volume and ADC values of enhancing areas for initial and follow-up MR imaging, and subtracted histograms were also prepared. The histogram parameters between groups were compared. The diagnostic accuracy of tumor progression based on the histogram parameters of initial and follow-up MR imaging and subtracted histograms was compared and correlated with overall survival.
  
  
  RESULTS
  Twenty-four pseudoprogressions and 11 tumor progressions were determined. Diagnosis based on the subtracted histogram mode with a multiparametric approach was more accurate than the diagnosis based on the uniparametric approach (area under the receiver operating characteristic curve of 0.877 versus 0.801), with 81.8% sensitivity and 100% specificity. A high mode of relative cerebral blood volume on the subtracted histogram by using a multiparametric approach (relative cerebral blood volume ×ADC) was the best predictor of true tumor progression (P < .001) and worse survival (P = .003).
  
  
  CONCLUSIONS
  Multiparametric histogram analysis of posttreatment glioblastoma was useful to predict true tumor progression and worse survival.
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: J
authors.initials: J
authors.lastname: Cha
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.) st7.kim@samsung.com.
authors.forename: S T
authors.initials: ST
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: B-J
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: Y K
authors.initials: YK
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: P
authors.initials: P
authors.lastname: Jeon
authors.affiliation: From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Neurosurgery (D.-s.K., D.-H.N.), Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: D-S
authors.initials: DS
authors.lastname: Kong
authors.affiliation: Neurosurgery (D.-s.K., D.-H.N.), Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: D-H
authors.initials: DH
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001932:Brain Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000009:adverse effects*; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009361:Neoplasm Invasiveness; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity