Advanced MRI increases the diagnostic accuracy of recurrent glioblastoma: Single institution thresholds and validation of MR spectroscopy and diffusion weighted MR imaging.
The accurate identification of glioblastoma progression remains an unmet clinical need. The aim of this prospective single-institutional study is to determine and validate thresholds for the main metabolite concentrations obtained by MR spectroscopy (MRS) and the values of the apparent diffusion coefficient (ADC) to enable distinguishing tumor recurrence from pseudoprogression. Thirty-nine patients after the standard treatment of a glioblastoma underwent advanced imaging by MRS and ADC at the time of suspected recurrence - median time to progression was 6.7 months. The highest significant sensitivity and specificity to call the glioblastoma recurrence was observed for the total choline (tCho) to total N-acetylaspartate (tNAA) concentration ratio with the threshold ≥ 1.3 (sensitivity 100.0% and specificity 94.7%). The ADCmean value higher than 1313 × 10(- 6) mm(2)/s was associated with the pseudoprogression (sensitivity 98.3%, specificity 100.0%). The combination of MRS focused on the tCho/tNAA concentration ratio and the ADCmean value represents imaging methods applicable to early non-invasive differentiation between a glioblastoma recurrence and a pseudoprogression. However, the institutional definition and validation of thresholds for differential diagnostics is needed for the elimination of setup errors before implementation of these multimodal imaging techniques into clinical practice, as well as into clinical trials.
International Clinical Research Center, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic; Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic.
Tomas
T
Kazda
International Clinical Research Center, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic; Department of Diagnostic Imaging, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Department of Diagnostic Imaging, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic.
Martin
M
Bulik
Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic.
Petr
P
Pospisil
Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
Radek
R
Lakomy
Department of Neurosurgery, University Hospital Brno, Brno 625 00, Czech Republic.
Martin
M
Smrcka
Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic.
Pavel
P
Slampa
Department of Neurosurgery, St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; Department of Neurosurgery, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic. Electronic address: radim.jancalek@fnusa.cz.
Radim
R
Jancalek
D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D002794:Choline / Q000378:metabolism; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging*; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018709:Statistics, Nonparametric
D001224:Aspartic Acid; D018698:Glutamic Acid; C000179:N-acetylaspartate; D002794:Choline
Apparent diffusion coefficient; Glioma; Imaging sensitivity; Recurrence; Spectroscopy