title: Progressive disease in glioblastoma: Benefits and limitations of semi-automated volumetry.
abstract: OBJECTIVE
  Unambiguous evaluation of glioblastoma (GB) progression is crucial, both for clinical trials as well as day by day routine management of GB patients. 3D-volumetry in the follow-up of GB provides quantitative data on tumor extent and growth, and therefore has the potential to facilitate objective disease assessment. The present study investigated the utility of absolute changes in volume (delta) or regional, segmentation-based subtractions for detecting disease progression in longitudinal MRI follow-ups.
  
  
  METHODS
  165 high resolution 3-Tesla MRIs of 30 GB patients (23m, mean age 60.2y) were retrospectively included in this single center study. Contrast enhancement (CV) and tumor-related signal alterations in FLAIR images (FV) were semi-automatically segmented. Delta volume (dCV, dFV) and regional subtractions (sCV, sFV) were calculated. Disease progression was classified for every follow-up according to histopathologic results, decisions of the local multidisciplinary CNS tumor board and a consensus rating of the neuro-radiologic report.
  
  
  RESULTS
  A generalized logistic mixed model for disease progression (yes / no) with dCV, dFV, sCV and sFV as input variables revealed that only dCV was significantly associated with prediction of disease progression (P = .005). Delta volume had a better accuracy than regional, segmentation-based subtractions (79% versus 72%) and a higher area under the curve by trend in ROC curves (.83 versus .75).
  
  
  CONCLUSIONS
  Absolute volume changes of the contrast enhancing tumor part were the most accurate volumetric determinant to detect progressive disease in assessment of GB and outweighed FLAIR changes as well as regional, segmentation-based image subtractions. This parameter might be useful in upcoming objective response criteria for glioblastoma.
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.|Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0002-8167-8651
authors.initials: T
authors.lastname: Huber
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Georgina
authors.initials: G
authors.lastname: Alber
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Bette
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kaesmacher
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Hanno M
authors.initials: HM
authors.lastname: Specht
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Wiestler
authors.affiliation: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Kirschke
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005909:Glioblastoma / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media