Abstract
Glioblastoma (GBM) is the most common malignant tumor of the central nervous system with poor prognosis. Although the field of immunotherapy in glioma is developing rapidly, glioblastoma is still prone to recurrence under strong immune intervention. The major challenges in the process of immunotherapy are evaluating the curative effect, accurately distinguishing between treatment-related reactions and tumor recurrence, and providing guidance for clinical decision-making. Since the conventional magnetic resonance imaging (MRI) is usually difficult to distinguish between pseudoprogression and the true tumor progression, many studies have used various advanced imaging techniques to evaluate treatment-related responses. Meanwhile, criteria for efficacy evaluation of immunotherapy are constantly updated and improved. A standard imaging scheme to evaluate immunotherapeutic response will benefit patients finally. This review mainly summarizes the application status and future trend of several advanced imaging techniques in evaluating the efficacy of GBM immunotherapy.
Highlights
Glioblastoma is the most common malignant brain tumor in adult and is extremely aggressive
Some studies have compared the diagnostic accuracy of DSC-magnetic resonance imaging (MRI) with threedimensional pseudocontinuous arterial spin labeling (3DpcASL) and suggested that the ability of 3D-pcASL perfusion imaging in distinguishing between pseudoprogression and tumor recurrence in GBM patients is almost the same as that of DSC, but 3D-pcASL is superior to DSC when the lesions are disturbed by magnetic susceptibility artifacts [44, 45]
In a study of advanced MRI assessing dendritic cell immunotherapy against GBM, it was found that the difference of relative cerebral blood volume (△rCBVmax) could effectively differentiate tumor recurrence from pseudoprogression, with a sensitivity of 67% and specificity of 75% (p = 0.004), suggesting that the value of △rCBV might be more helpful to distinguish them than the absolute value of rCBV during follow-up [29] (Figure 1)
Summary
Glioblastoma is the most common malignant brain tumor in adult and is extremely aggressive. These perfusion parameters can be used to distinguish between pseudoprogression and tumor recurrence in GBM patients receiving standard treatment or immunotherapy [30, 40].
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