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Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including Pseudoprogression from Recurrent Tumors in High-Grade Gliomas with Histopathologic Evidence

Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including... 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 ADC Lesion 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. ABBREVIATIONS: AUC area under the curve HGG high-grade glioma HR hazard ratio NL normal contralateral white matter MGMT O6-methylguanine-DNA methyltransferase PSR percentage signal recovery rCBV relative cerebral blood volume ROC receiver operating characteristic RT radiation therapy http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including Pseudoprogression from Recurrent Tumors in High-Grade Gliomas with Histopathologic Evidence

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2015 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A4218
pmid
25593202
Publisher site
See Article on Publisher Site

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 ADC Lesion 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. ABBREVIATIONS: AUC area under the curve HGG high-grade glioma HR hazard ratio NL normal contralateral white matter MGMT O6-methylguanine-DNA methyltransferase PSR percentage signal recovery rCBV relative cerebral blood volume ROC receiver operating characteristic RT radiation therapy

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: May 1, 2015

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