Abstract
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.
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Acknowledgments
Julio Arevalo-Perez was supported by a grant from the Spanish foundation “Fundación Alfonso Martín Escudero”. Weiji Shi and Zhigang Zhang’s research was partly supported by an NIH Core Grant P30 CA008748.
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Drs. Thomas, Arevalo-Perez, Kaley, and Young participated in the design the study. Drs. Thomas, Arevalo-Perez, Peck, Shi, Zhang, and Young participated in the study conduct and gathered and interpreted the data. All authors were involved in the preparation of the report, and reviewed both the draft and final versions.
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Alissa A. Thomas and Julio Arevalo-Perez have contributed equally.
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11060_2015_1893_MOESM1_ESM.jpg
Supplementary material 1 (JPEG 165 kb) Supplemental Fig. 1: MRI examples pseudoprogression (top) and progression (bottom) in patients with glioblastoma following standard radiation and temozolomide. From left to right, the images demonstrate the baseline axial T1-post contrast MRI scan after surgical resection, a T1-post contrast MRI scan suggestive of progression versus pseudoprogression, the corresponding DCE-MRI blood plasma volume (Vp) parametric map, the corresponding DCE-MRI time dependent leakage constant (Ktrans) parametric map, and an axial FLAIR image
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Thomas, A.A., Arevalo-Perez, J., Kaley, T. et al. Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma. J Neurooncol 125, 183–190 (2015). https://doi.org/10.1007/s11060-015-1893-z
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DOI: https://doi.org/10.1007/s11060-015-1893-z