Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma

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• 作者：Alissa A. Thomas ; Julio Arevalo-Perez ; Thomas Kaley ; John Lyo…
• 关键词：Glioblastoma ; DCE MRI ; Pseudoprogression ; Perfusion
• 刊名：Journal of Neuro-Oncology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：125
• 期：1
• 页码：183-190
• 全文大小：846 KB
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• 作者单位：Alissa A. Thomas (1)
  Julio Arevalo-Perez (2)
  Thomas Kaley (1) (5)
  John Lyo (2) (5)
  Kyung K. Peck (3)
  Weiji Shi (4)
  Zhigang Zhang (4)
  Robert J. Young (2) (5)
  
  1. Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
  2. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
  5. The Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
  3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
  4. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

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. Keywords Glioblastoma DCE MRI Pseudoprogression Perfusion