Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging
- 1 May 2013
- journal article
- Published by SAGE Publications in Acta Radiologica
- Vol. 54 (4), 448-454
- https://doi.org/10.1177/0284185112474916
Abstract
Background Pseudoprogression is a treatment-related reaction with an increase in contrast-enhancing lesion size, followed by subsequent improvement. Differentiating tumor recurrence from pseudoprogression remains a problem in neuro-oncology. Purpose To validate the added value of arterial spin labeling (ASL), compared with dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) alone, in distinguishing early tumor progression from pseudoprogression in patients with newly diagnosed glioblastoma multiforme (GBM). Material and Methods We retrospectively evaluated 117 consecutive patients with newly diagnosed GBM who underwent surgical resection and concurrent chemoradiotherapy (CCRT) as standard treatment modality. Sixty-two patients who developed contrast-enhancing lesions were assessed by both ASL and DSC perfusion MRI and classified into groups of early tumor recurrence ( n = 34) or pseudoprogression ( n = 28) based on pathologic analysis or clinical–radiologic follow-up. We used a qualitative analysis and semi-quantitative grade system on the basis of the tumor perfusion signal intensity into those equal to white matter (grade I), gray matter (grade II), and blood vessels (grade III) on ASL imaging. ASL grade was correlated with histogram parameters derived from DSC perfusion MRI. Results Pseudoprogression was observed in 15 (53.6%) patients with ASL grade I, 13 (46.4%) with grade II, and 0 (0%) with grade III, with early tumor progression observed in seven (20.6%) patients with ASL grade I, 11 (32.3%) with grade II, and 16 (47.1%) with grade III ( P = 0.0022). DSC perfusion histogram parameters differed significantly among ASL grades. ASL grade was an independent predictor differentiating pseudoprogression from early tumor progression (odds ratio, 4.73; P = 0.0017). On qualitative review, adjunctive ASL produced eight (12.9%) more accurate results than DSC perfusion MRI alone. Conclusion ASL improves the diagnostic accuracy of DSC perfusion MRI in differentiating pseudoprogression from early tumor progression.Keywords
This publication has 33 references indexed in Scilit:
- Updated Response Assessment Criteria for High-Grade Gliomas: Response Assessment in Neuro-Oncology Working GroupJournal of Clinical Oncology, 2010
- Incidence of early pseudo‐progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomideCancer, 2008
- Clinical features, mechanisms, and management of pseudoprogression in malignant gliomasThe Lancet Oncology, 2008
- Diagnostic accuracy and interobserver variability of pulsed arterial spin labeling for glioma gradingActa Radiologica, 2008
- A Prospective Study on the Added Value of Pulsed Arterial Spin-Labeling and Apparent Diffusion Coefficients in the Grading of GliomasAmerican Journal of Neuroradiology, 2007
- Differentiation of recurrent brain tumor versus radiation injury using diffusion tensor imaging in patients with new contrast-enhancing lesionsMagnetic Resonance Imaging, 2006
- Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastomaJournal of Neuro-Oncology, 2006
- PET imaging for differentiating recurrent brain tumor from radiation necrosisRadiologic Clinics of North America, 2005
- Diffusion weighted imaging in radiation necrosisJournal of Neurology, Neurosurgery & Psychiatry, 2003
- Dynamic susceptibility contrast MRI of gliomasNeuroimaging Clinics of North America, 2002