Perfusion MRI-based differentiation between early tumor progression and pseudoprogression in glioblastoma and its use in clinical practice

Neuro-Oncology Practice, vol. 12, pp. 281–290

Abstract

Background: Early treatment effects in patients with glioblastoma are frequently discussed during multidisciplinary team meetings (MDTM), after which a decision regarding (dis)continuation of tumor-targeted treatment is made. This study examined whether a separate and systematic evaluation of perfusion MRI (pMRI) could impact such treatment decisions in the early stage. Methods: This retrospective observational study evaluated the diagnostic accuracy for detecting early tumor progression of 4 different approaches including conventional MRI, pMRI with Arterial Spin Labeling (ASL), and/or Dynamic Susceptibility Contrast (DSC) MRI, and compared those to the MDTM evaluation in clinical practice. Results: Sixty-five glioblastoma patients with clinical and radiological data until 9 months after irradiation were included. For all approaches, the sensitivity for detecting early true disease progression was poor to moderate (32%-62%). Area under the curve values were comparable (range 0.63-0.74), but highest for the MDTM evaluation (0.74). In the cases of inconclusive MDTM (26%), systematic pMRI evaluation showed a higher sensitivity compared to conventional MRI (respectively, 36% vs 0%), while the specificity was 100% for all MRI approaches. Multivariable regression analysis showed that a lower KPS score (OR = 0.84 [95% CI: 0.77-0.91]) and pMRI indicative of tumor progression (OR = 0.09 [95% CI: 0.02-0.52]) were independently associated with concluding tumor progression at the MDTM. Conclusion: MDTM assessment in daily clinical practice has a higher diagnostic accuracy in distinguishing early tumor progression from pseudoprogression compared to a separate, systematic evaluation of pMRI. Systematic evaluation of pMRI might be helpful if the clinical MDTM assessment is uncertain.

Authors 10

1. Daniëlle van Dorth corresponding Aachen C.J. Gorter MRI Center Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center , Leiden ,

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

2. Robert Croese Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurology, Haaglanden Medical Center , Den Haag ,

   Department of Neurology, Leiden University Medical Center , Leiden ,

   Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands

   Department of Neurology, Leiden University Medical Center, Leiden, Netherlands

3. Feng Yan Jiang Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Radiology, HagaZiekenhuis , Den Haag ,

   Department of Radiology, Leiden University Medical Center , Leiden ,

   Department of Radiology, HagaZiekenhuis, Den Haag, Netherlands

   Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

4. Bárbara Schmitz‐Abecassis Aachen C.J. Gorter MRI Center Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center · Medical Delta

   Affiliation as printed

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center , Leiden ,

   Medical Delta , Delft ,

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

   Medical Delta, Delft, Netherlands

5. MARTIN J.B. TAPHOORN Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurology, Haaglanden Medical Center , Den Haag ,

   Department of Neurology, Leiden University Medical Center , Leiden ,

   Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands

   Department of Neurology, Leiden University Medical Center, Leiden, Netherlands

6. Marion Smits

   Erasmus MC · Erasmus MC Cancer Institute · Medical Delta

   Affiliation as printed

   Brain Tumor Center, Erasmus MC Cancer Institute , Rotterdam ,

   Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam , Rotterdam ,

   Medical Delta , Delft ,

   Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands

   Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands

   Medical Delta, Delft, Netherlands

7. Linda Dirven Aachen Department of Neurology, Leiden University Medical Center (LUMC)

   Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Neurology, Haaglanden Medical Center , Den Haag ,

   Department of Neurology, Leiden University Medical Center , Leiden ,

   Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands

   Department of Neurology, Leiden University Medical Center, Leiden, Netherlands

8. Matthias J.P. van Osch Aachen C.J. Gorter MRI Center Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center · Medical Delta

   Affiliation as printed

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center , Leiden ,

   Medical Delta , Delft ,

   C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

   Medical Delta, Delft, Netherlands

9. Jeroen de Bresser Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center , Leiden ,

   Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

10. Johan A F Koekkoek Aachen Department of Neurology, Leiden University Medical Center (LUMC)

    Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

    Affiliation as printed

    Department of Neurology, Haaglanden Medical Center , Den Haag ,

    Department of Neurology, Leiden University Medical Center , Leiden ,

    Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands

    Department of Neurology, Leiden University Medical Center, Leiden, Netherlands