Diffusion and perfusion MRI to differentiate treatment-related changes including pseudoprogression from recurrent tumors in high-grade gliomas with histopathologic evidence Journal Article

   

Authors:	Prager, A. J.; Martinez, N.; Beal, K.; Omuro, A.; Zhang, Z.; Young, R. J.
Article Title:	Diffusion and perfusion MRI to differentiate treatment-related changes including pseudoprogression from recurrent tumors in high-grade gliomas with histopathologic evidence
Abstract:	BACKGROUND AND PURPOSE: Treatment-related changes and recurrent tumors often have overlapping features on conventional MR imaging. The purpose of this study was to assess the utility of DWI and DSC perfusion imaging alone and in combination to differentiate treatment-related effects and recurrent high-grade gliomas. MATERIALS AND METHODS: We retrospectively identified 68 consecutive patients with high-grade gliomas treated by surgical resection followed by radiation therapy and temozolomide, who then developed increasing enhancing mass lesions indeterminate for treatment-related changes versus recurrent tumor. All lesions were diagnosed by histopathology at repeat surgical resection. ROI analysis was performed of the enhancing lesion on the ADC and DSC maps. Measurements made by a 2D ROI of the enhancing lesion on a single slice were recorded as ADC(Lesion) and rCBV(Lesion), and measurements made by the most abnormal small fixed diameter ROI as ADC(ROI) and rCBV(ROI). Statistical analysis was performed with Wilcoxon rank sum tests with P = .05. RESULTS: Ten of the 68 patients (14.7%) had treatment-related changes, while 58 patients (85.3%) had recurrent tumor only (n = 19) or recurrent tumor mixed with treatment effect (n = 39). DWI analysis showed higher ADC(Lesion), in treatment-related changes than in recurrent tumor (P = .003). DSC analysis revealed lower relative cerebral blood volume (rCBV)(Lesion) and rCBV(ROI) in treatment-related changes (P = .003 and P = .011, respectively). Subanalysis of patients with suspected pseudoprogression also revealed higher ADC(Lesion) (P = .001) and lower rCBV(Lesion) (P = .028) and rCBV(ROI) (P = .032) in treatment-related changes. Applying a combined A DCLesion and rCBV(Lesion) model did not outperform either the ADC or rCBV metric alone. CONCLUSIONS: Treatment-related changes showed higher diffusion and lower perfusion than recurrent tumor. Similar correlations were found for patients with suspected pseudoprogression.
Keywords:	brain; progression; spectroscopy; radiation necrosis; injury; pseudoresponse; measurements; newly-diagnosed glioblastoma; blood-volume; histogram analysis; intracranial mass lesions
Journal Title:	American Journal of Neuroradiology
Volume:	36
Issue:	5
ISSN:	0195-6108
Publisher:	American Society of Neuroradiology
Date Published:	2015-05-01
Start Page:	877
End Page:	885
Language:	English
ACCESSION:	WOS:000354828700014
DOI:	10.3174/ajnr.A4218
PROVIDER:	wos
PUBMED:	25593202
PMCID:	PMC4731220
Notes:	Article -- Source: Wos

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