Abstract
Determining whether glioblastoma multiforme (GBM) is progressing despite treatment is challenging due to the pseudoprogression phenomenon seen on conventional MRIs, but relative cerebral blood volume (CBV) has been shown to be helpful. As CBV's calculation from perfusion-weighted images is not standardized, we investigated whether there were differences between three FDA-cleared software packages in their CBV output values and subsequent performance regarding predicting survival/progression. Forty-five postradiation therapy GBM cases were retrospectively identified as having indeterminate MRI findings of progression versus pseudoprogression. The dynamic susceptibility contrast MR images were processed with different software and three different relative CBV metrics based on the abnormally enhancing regions were computed. The intersoftware intraclass correlation coefficients were 0.8 and below, depending on the metric used. No statistically significant difference in progression determination performance was found between the software packages, but performance was better for the cohort imaged at 3.0 T versus those imaged at 1.5 T for many relative CBV metric and classification criteria combinations. The results revealed clinically significant variation in relative CBV measures based on the software used, but minimal interoperator variation. We recommend against using specific relative CBV measurement thresholds for GBM progression determination unless the same software or processing algorithm is used.
Highlights
Glioblastoma multiforme (GBM) is the most common adult, primary brain cancer and carries a poor prognosis
Median survival in patients treated on clinical trials with radiation therapy and temozolomide ranges from 15 to 20 months.[1,2]
Dynamic susceptibility contrast (DSC) perfusion imaging is widely used in brain tumor imaging
Summary
Glioblastoma multiforme (GBM) is the most common adult, primary brain cancer and carries a poor prognosis. In a study examining the incidence of progression versus pseudoprogression in 63 GBM patients,[5 28] (44.4%) of the patients had lesion enlargement with the first postradiation follow-up MR exam Each of these cases underwent salvage surgery and pathologic analysis, resulting in 12 (42.8%) being classified as pseudoprogression, with the other 16 (57.2%) exhibiting true tumor progression. In the largest study regarding conventional imaging of progression versus pseudoprogression, qualitative features were analyzed regarding their ability to distinguish between the two phenomena.[6] With 63 progression and 30 pseudoprogression patients, the only feature found to have predictive value regarding progression was subependymal enhancement This was only present in 26 of the 93 cases, producing a negative predictive value of 41.8%, and is not a good candidate for attempting to extract further value through quantitative assessment since a radiologist would not Journal of Medical Imaging
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