title: Diagnosis of pseudoprogression using MRI perfusion in patients with glioblastoma multiforme may predict improved survival.
abstract: OBJECTIVE
  This retrospective study determined the survival of glioblastoma patients with or without pseudoprogression.
  
  
  METHODS
  A total of 68 patients were included. Overall survival was compared between patients showing pseudoprogression (in most cases diagnosed using perfusion MRI with ferumoxytol) and in patients without pseudoprogession. MGMT methylation status was also analyzed in the pseudoprogression cases.
  
  
  RESULTS
  Median survival in 24 (35.3%) patients with pseudoprogression was 34.7 months (95% CI: 20.3-54.1), and 13.4 months (95% CI: 11.1-19.5) in 44 (64.7%) patients without pseudoprogression (p < 0.0001). The longest survival was a median of 54.1 months in patients with combination of pseudoprogression and (MGMT) promoter methylation.
  
  
  CONCLUSIONS
  Pseudoprogression is associated with better outcome, especially if concurring with MGMT promoter methylation. Patients never diagnosed with pseudoprogression had poor survival. This study emphasizes the importance of differentiating tumor progression and pseudoprogression using perfusion MRI.
authors.affiliation: Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Seymur
authors.initials: S
authors.lastname: Gahramanov
authors.forename: Csanad
authors.initials: C
authors.lastname: Varallyay
authors.forename: Rose Marie
authors.initials: RM
authors.lastname: Tyson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lacy
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Joao Prola
authors.initials: JP
authors.lastname: Netto
authors.forename: Morad
authors.initials: M
authors.lastname: Nasseri
authors.forename: Tricia
authors.initials: T
authors.lastname: White
authors.forename: Randy L
authors.initials: RL
authors.lastname: Woltjer
authors.forename: Sakir Humayun
authors.initials: SH
authors.lastname: Gultekin
authors.forename: Edward A
authors.initials: EA
authors.lastname: Neuwelt
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D059248:Chemoradiotherapy; D015254:DNA Modification Methylases / Q000235:genetics; D045643:DNA Repair Enzymes / Q000235:genetics; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011401:Promoter Regions, Genetic / Q000235:genetics; D012189:Retrospective Studies; D025521:Tumor Suppressor Proteins / Q000235:genetics
chemical_list: D025521:Tumor Suppressor Proteins; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes
keywords: ferumoxytol; glioblastoma; perfusion MRI; pseudoprogression; temozolomide