Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma.
Pseudoprogression may present as transient new or increasing enhancing lesions that mimic recurrent tumors in treated glioblastoma. The purpose of this study was to examine the utility of dynamic contrast enhanced T1 magnetic resonance imaging (DCE MRI) in differentiating between pseudoprogression and tumor progression and devise a cut-off value sensitive for pseudoprogression. We retrospectively examined 37 patients with glioblastoma treated with radiation and temozolomide after surgical resection that then developed new or increasing enhancing lesion(s) indeterminate for pseudoprogression versus progression. Volumetric plasma volume (Vp) and time-dependent leakage constant (Ktrans) maps were measured for the enhancing lesion and the mean and ninetieth percentile histogram values recorded. Lesion outcome was determined by clinical follow up with pseudoprogression defined as stable disease not requiring new treatment. Statistical analysis was performed with Wilcoxon rank-sum tests. Patients with pseudoprogression (n = 13) had Vp (mean) = 2.4 and Vp (90 %tile) = 3.2; and Ktrans (mean) = 3.5 and Ktrans (90 %tile) = 4.2. Patients with tumor progression (n = 24) had Vp (mean) = 5.3 and Vp (90 %tile) = 6.6; and Ktrans (mean) = 7.4 and Ktrans (90 %tile) = 9.1. Compared with tumor progression, pseudoprogression demonstrated lower Vp perfusion values (p = 0.0002) with a Vp (mean) cutoff <3.7 yielding 85% sensitivity and 79% specificity for pseudoprogression. Ktrans (mean) of >3.6 had a 69% sensitivity and 79% specificity for disease progression. DCE MRI shows lower plasma volume and time dependent leakage constant values in pseudoprogression than in tumor progression. A cut-off value with high sensitivity for pseudoprogression can be applied to aid in interpretation of DCE MRI.
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Alissa A
AA
Thomas
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Julio
J
Arevalo-Perez
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.|The Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Thomas
T
Kaley
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.|The Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
John
J
Lyo
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Kyung K
KK
Peck
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Weiji
W
Shi
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Zhigang
Z
Zhang
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. youngr@mskcc.org.|The Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. youngr@mskcc.org.
Robert J
RJ
Young
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000470:Alkaloids; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D003287:Contrast Media / Q000378:metabolism*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy; D012372:ROC Curve; D012189:Retrospective Studies; D000077204:Temozolomide; D013997:Time Factors; D016896:Treatment Outcome
D000470:Alkaloids; D018906:Antineoplastic Agents, Alkylating; D003287:Contrast Media; C110131:Wilcox compound; D003606:Dacarbazine; D000077204:Temozolomide
DCE MRI; Glioblastoma; Perfusion; Pseudoprogression