Combined use of susceptibility weighted magnetic resonance imaging sequences and dynamic susceptibility contrast perfusion weighted imaging to improve the accuracy of the differential diagnosis of recurrence and radionecrosis in high-grade glioma patients.
Purpose was to assess predictive power for overall survival (OS) and diagnostic performance of combination of susceptibility-weighted MRI sequences (SWMRI) and dynamic susceptibility contrast (DSC) perfusion-weighted imaging (PWI) for differentiation of recurrence and radionecrosis in high-grade glioma (HGG). We enrolled 51 patients who underwent radiation therapy or gamma knife surgeryfollowed by resection for HGG and who developed new measurable enhancement more than six months after complete response. The lesions were confirmed as recurrence (n = 32) or radionecrosis (n = 19). The mean and each percentile value from cumulative histograms of normalized CBV (nCBV) and proportion of dark signal intensity on SWMRI (proSWMRI, %) within enhancement were compared. Multivariate regression was performed for the best differentiator. The cutoff value of best predictor from ROC analysis was evaluated. OS was determined with Kaplan-Meier method and log-rank test. Recurrence showed significantly lower proSWMRI and higher mean nCBV and 90th percentile nCBV (nCBV90) than radionecrosis. Regression analysis revealed both nCBV90 and proSWMRI were independent differentiators. Combination of nCBV90 and proSWMRI achieved 71.9% sensitivity (23/32), 100% specificity (19/19) and 82.3% accuracy (42/51) using best cut-off values (nCBV90 > 2.07 and proSWMRI≤15.76%) from ROC analysis. In subgroup analysis, radionecrosis with nCBV > 2.07 (n = 5) showed obvious hemorrhage (proSWMRI > 32.9%). Patients with nCBV90 > 2.07 and proSWMRI≤15.76% had significantly shorter OS. In conclusion, compared with DSC PWI alone, combination of SWMRI and DSC PWI have potential to be prognosticator for OS and lower false positive rate in differentiation of recurrence and radionecrosis in HGG who develop new measurable enhancement more than six months after complete response.
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Tae-Hyung
TH
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Tae Jin
TJ
Yun
Department of Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Chul-Kee
CK
Park
Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Tae Min
TM
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Ji-Hoon
JH
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Chul-Ho
CH
Sohn
Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
Jae Kyung
JK
Won
Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
Sung-Hye
SH
Park
Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
Il Han
IH
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.|Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.|Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea.
Seung Hong
SH
Choi
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012372:ROC Curve; D011832:Radiation Injuries / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity
dynamic susceptibility contrast perfusion-weighted imaging; magnetic resonance imaging; radionecrosis, recurrence; susceptibility-weighted magnetic resonance imaging sequences