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Dynamic contrast-enhanced MR imaging in predicting progression of enhancing lesions persisting after standard treatment in glioblastoma patients: a prospective study

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Abstract

Objectives

To prospectively explore the value of dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI) in predicting the progression of enhancing lesions persisting after standard treatment in patients with surgically resected glioblastoma (GBM).

Methods

Forty-seven GBM patients, who underwent near-total tumorectomy followed by concurrent chemoradiation therapy (CCRT) with temozolomide (TMZ) between May 2014 and February 2016, were enrolled. Twenty-four patients were finally analyzed for measurable enhancing lesions persisting after standard treatment. DCE-MRI parameters were calculated at enhancing lesions. Mann–Whitney U tests and multivariable stepwise logistic regression were used to compare parameters between progression (n = 16) and non-progression (n = 8) groups.

Results

Mean Ktrans and ve were significantly lower in progression than in non-progression (P = 0.037 and P = 0.037, respectively). The 5th percentile of the cumulative Ktrans histogram was also significantly lower in the progression than in non-progression group (P = 0.017). Mean ve was the only independent predictor of progression (P = 0.007), with a sensitivity of 100%, specificity of 63%, and an overall accuracy of 88% at a cut-off value of 0.873.

Conclusions

DCE-MRI may help predict the progression of enhancing lesions persisting after the completion of standard treatment in patients with surgically resected GBM, with mean ve serving as an independent predictor of progression.

Key points

• Enhancing lesions may persist after standard treatment in GBM patients.

• DCE-MRI may help predict the progression of the enhancing lesions.

• Mean K trans and v e were lower in progression than in non-progression group.

• DCE-MRI may help identify patients requiring close follow-up after standard treatment.

• DCE-MRI may help plan treatment strategies for GBM patients.

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Abbreviations

AIF:

Arterial input function

BBB:

Blood–brain barrier

CBV:

Cerebral blood volume

CCRT:

Concurrent radiation therapy and chemotherapy

CI:

Confidence interval

DCE:

Dynamic contrast-enhanced

F-FMISO:

18F-fluoromisonidazole

FLAIR:

Fluid-attenuated inversion recovery sequence

FOV:

Field of view

GBM:

Glioblastoma

IQR:

Interquartile range

MGMT:

O6-Methylguanine DNA methyltransferase

MPRAGE:

Magnetization-prepared rapid acquisition gradient echo

NEX:

Number of excitations

RANO:

Response assessment in neuro-oncology

ROC:

Receiver operating characteristic

ROI:

Region of interest

TE:

Echo time

TI:

Inversion time

TMZ:

Temozolomide

TR:

Repetition time

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

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Acknowledgements

The scientific guarantor of this publication is Seung Hong Choi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study was supported by a grant from Bayer Healthcare, the Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs (HI16C1111), by the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2016M3C7A1914002), by Creative-Pioneering Researchers Program through Seoul National University (SNU), and by project code (IBS-R006-D1).

One of the authors (R.E.Y.) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Some study subjects or cohorts (n = 10) have been previously reported in “Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy: differentiation of true progression from pseudoprogression with quantitative dynamic contrast-enhanced MR imaging” (Radiology 2015;274(3):830–40). However, the main focus of the present study was to evaluate DCE-MRI findings of the patients at a different time point (i.e., after the completion of standard treatment) and to explore whether DCE pharmacokinetic parameters may predict the progression of enhancing lesions persisting after the completion of standard treatment in the patients with surgically resected GBM.

Methodology: prospective, case-control study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, 110-744, Seoul, Korea

    Roh-Eul Yoo, Seung Hong Choi, Hye Jeong Choi, Sung-Hye You, Koung Mi Kang, Tae Jin Yun, Ji-Hoon Kim & Chul-Ho Sohn

  2. Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, 151-742, Seoul, Korea

    Seung Hong Choi

  3. School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea

    Seung Hong Choi

  4. Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Tae Min Kim

  5. Department of Neurosurgery, Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Chul-Kee Park

  6. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Sung-Hye Park & Jae-Kyung Won

  7. Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Il Han Kim

  8. Department of Neurology, Seoul National University College of Medicine, Seoul, Korea

    Soon Tae Lee

Authors
  1. Roh-Eul Yoo
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  2. Seung Hong Choi
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Correspondence to Seung Hong Choi.

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Yoo, RE., Choi, S.H., Kim, T.M. et al. Dynamic contrast-enhanced MR imaging in predicting progression of enhancing lesions persisting after standard treatment in glioblastoma patients: a prospective study. Eur Radiol 27, 3156–3166 (2017). https://doi.org/10.1007/s00330-016-4692-9

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