Abstract
To evaluate single- and multiparametric MRI models to differentiate recurrent glioblastoma (GBM) and treatment-related changes (TRC) in clinical routine imaging. Selective and unselective apparent diffusion coefficient (ADC) and minimum, mean, and maximum cerebral blood volume (CBV) measurements in the lesion were performed. Minimum, mean, and maximum ratiosCBV (CBVlesion to CBVhealthy white matter) were computed. All data were tested for lesion discrimination. A multiparametric model was compiled via multiple logistic regression using data demonstrating significant difference between GBM and TRC and tested for its diagnostic strength in an independent patient cohort. A total of 34 patients (17 patients with recurrent GBM and 17 patients with TRC) were included. ADC measurements showed no significant difference between both entities. All CBV and ratiosCBV measurements were significantly higher in patients with recurrent GBM than TRC. A minimum CBV of 8.5, mean CBV of 116.5, maximum CBV of 327 and ratioCBV minimum of 0.17, ratioCBV mean of 2.26 and ratioCBV maximum of 3.82 were computed as optimal cut-off values. By integrating these parameters in a multiparametric model and testing it in an independent patient cohort, 9 of 10 patients, i.e., 90%, were classified correctly. The multiparametric model further improves radiological discrimination of GBM from TRC in comparison to single-parameter approaches and enables reliable identification of recurrent tumors.
Highlights
Is often reliably feasible due to its typical radiological features, e.g., peripheral irregular ring enhancement, intralesional hemorrhage, and central necrosis [7,27,28], imaging of recurrent and/or progressive residual high-grade GBM is similar to therapy associated cerebral radiation necrosis or pseudoprogression after surgical resection and concomitant radiochemotherapy; both show strong contrast enhancement, increasing fluid-attenuated inversion recovery (FLAIR) hyperintensities adjacent to the enhancement, and present with punctiform intralesional hemorrhage and necrosis [29,30]
To validate the multiparametric model, it was tested for its diagnostic strength in an independent patient cohort with recurrent glioblastoma or treatment-related changes (TRC)
A total of 75 GBM patients with a new contrast-enhancing lesion after initial radical surgical resection followed by radiotherapy and concomitant chemotherapy of histologically proven GBM were introduced in our interinstitutional tumor board
Summary
Whereas initial diagnosis of GBM is often reliably feasible due to its typical radiological features, e.g., peripheral irregular ring enhancement, intralesional hemorrhage, and central necrosis [7,27,28], imaging of recurrent and/or progressive residual high-grade GBM is similar to therapy associated cerebral radiation necrosis (increasing contrast enhancement and progressive peritumoral edema at least six months up to several years after radiotherapy [29], often progresses without treatment) or pseudoprogression (increasing contrast enhancement and progressive peritumoral edema within three to six months following radiotherapy, often resolves spontaneously) after surgical resection and concomitant radiochemotherapy; both show strong contrast enhancement, increasing fluid-attenuated inversion recovery (FLAIR) hyperintensities adjacent to the enhancement, and present with punctiform intralesional hemorrhage and necrosis [29,30]
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