Nasseri Morad, Gahramanov Seymur, Netto Joao Prola, Fu Rongwei, Muldoon Leslie L, Varallyay Csanad, Hamilton Bronwyn E, Neuwelt Edward A
Department of Neurology, Oregon Health & Science University, Portland, Oregon (M.N., S.G., J.P.N., L.L.M., C.V., E.A.N.); Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, Oregon (R.F.); Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon (R.F.); Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon (B.E.H.); Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon (E.A.N.); Department of Veterans Affairs Medical Center, Portland, Oregon (E.A.N.); Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington (S.G.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (M.N.).
Neuro Oncol. 2014 Aug;16(8):1146-54. doi: 10.1093/neuonc/not328. Epub 2014 Feb 11.
Diagnosis of pseudoprogression in patients with glioblastoma multiforme (GBM) is limited by Response Assessment in Neuro-Oncology (RANO) criteria to 3 months after chemoradiotherapy (CRT). Frequency of pseudoprogression occurring beyond this time limit was determined. Survival comparison was made between pseudoprogression and true progression patients as determined by using perfusion magnetic resonance imaging with ferumoxytol (p-MRI-Fe).
Fifty-six patients with GBM who demonstrated conventional findings concerning for progression of disease post CRT were enrolled in institutional review board-approved MRI protocols. Dynamic susceptibility-weighted contrast-enhanced p-MRI-Fe was used to distinguish true progression from pseudoprogression using relative cerebral blood volume (rCBV) values. rCBV of 1.75 was assigned as the cutoff value. Participants were followed up using RANO criteria, and survival data were analyzed.
Twenty-seven participants (48.2%) experienced pseudoprogression. Pseudoprogression occurred later than 3 months post CRT in 8 (29.6%) of these 27 participants (ie, 8 [14.3%] of the 56 patients meeting the inclusion criteria). Overall survival was significantly longer in participants with pseudoprogression (35.2 months) compared with those who never experienced pseudoprogression (14.3 months; P < .001).
Pseudoprogression presented after 3 months post CRT in a considerable portion of patients with GBM, which raises doubts about the value of the 3-month time limit of the RANO criteria. Accurate rCBV measurement (eg, p-MRI-Fe) is suggested when there are radiographical concerns about progression of disease in GBM patients, regardless of any time limit. Pseudoprogression correlates with significantly better survival outcomes.
多形性胶质母细胞瘤（GBM）患者假性进展的诊断受神经肿瘤学反应评估（RANO）标准限制，仅适用于放化疗（CRT）后3个月内。本研究确定了超出此时间限制出现假性进展的频率。通过使用含多聚麦芽糖铁的灌注磁共振成像（p-MRI-Fe）来区分假性进展和真性进展患者，并对两者的生存率进行了比较。
56例GBM患者在接受CRT后出现符合疾病进展的常规影像学表现，被纳入机构审查委员会批准的MRI方案。使用动态磁敏感对比增强p-MRI-Fe，通过相对脑血容量（rCBV）值区分真性进展和假性进展。将rCBV值1.75作为临界值。按照RANO标准对参与者进行随访，并分析生存数据。
27名参与者（48.2%）出现假性进展。在这27名参与者中，有8名（29.6%）在CRT后3个月后出现假性进展（即符合纳入标准的56例患者中的8例[14.3%]）。与从未经历过假性进展的参与者（14.3个月；P < 0.001）相比，出现假性进展的参与者的总生存期显著更长（35.2个月）。
相当一部分GBM患者在CRT后3个月后出现假性进展，这对RANO标准3个月的时间限制的价值提出了质疑。当对GBM患者的疾病进展存在影像学疑虑时，无论时间限制如何，建议进行准确的rCBV测量（如p-MRI-Fe）。假性进展与显著更好的生存结果相关。
