Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
University of Zurich, Switzerland.
Eur J Radiol. 2023 Oct;167:111076. doi: 10.1016/j.ejrad.2023.111076. Epub 2023 Sep 1.
The purpose of this retrospective study was to compare two, widely available software packages for calculation of Dynamic Susceptibility Contrast (DSC) perfusion MRI normalized relative Cerebral Blood Volume (rCBV) values to differentiate tumor progression from pseudoprogression in treated high-grade glioma patients.
rCBV maps processed by Siemens Syngo.via (Siemens Healthineers) and Olea Sphere (Olea Medical) software packages were co-registered to contrast-enhanced T1 (T1-CE). Regions of interest based on T1-CE were transferred to the rCBV maps. rCBV was calculated using mean values and normalized using contralateral normal- appearing white matter. The Wilcoxon test was performed to assess for significant differences, and software-specific optimal rCBV cutoff values were determined using the Youden index. Interrater reliability was evaluated for two raters using the intraclass correlation coefficient.
41 patients (18 females; median age = 59 years; range 21-77 years) with 49 new or size-increasing post-treatment contrast-enhancing lesions were included (tumor progression = 40 lesions; pseudoprogression = 9 lesions). Optimal rCBV cutoffs of 1.31 (Syngo.via) and 2.40 (Olea) were significantly different, with an AUC of 0.74 and 0.78, respectively. Interrater reliability was 0.85.
We demonstrate that different clinically available MRI DSC-perfusion software packages generate significantly different rCBV cutoff values for the differentiation of tumor progression from pseudoprogression in standard-of-care treated high grade gliomas. Physicians may want to determine the unique value of their perfusion software packages on an institutional level in order to maximize diagnostic accuracy when faced with this clinical challenge. Furthermore, combined with implementation of current DSC-perfusion recommendations, multi-center comparability will be improved.
本回顾性研究的目的是比较两种广泛应用的软件包，以计算动态对比磁共振灌注成像（DSC）标准化相对脑血容量（rCBV）值，从而区分治疗后高级别胶质瘤患者的肿瘤进展与假性进展。
西门子 Syngo.via（西门子医疗）和 Olea Sphere（Olea Medical）软件包处理的 rCBV 图与对比增强 T1（T1-CE）进行配准。基于 T1-CE 的感兴趣区域被转移到 rCBV 图上。使用平均值计算 rCBV，并使用对侧正常白质进行标准化。采用 Wilcoxon 检验评估显著性差异，并使用 Youden 指数确定软件特异性最佳 rCBV 截断值。采用组内相关系数评估两位评分者的组内可靠性。
共纳入 41 例女性患者（18 例；中位年龄为 59 岁；年龄范围为 21-77 岁），其中 49 例为新发病灶或治疗后增大的对比增强病灶（肿瘤进展 40 例，假性进展 9 例）。Syngo.via 和 Olea 的最佳 rCBV 截断值分别为 1.31 和 2.40，差异有统计学意义，曲线下面积分别为 0.74 和 0.78。评分者间的组内可靠性为 0.85。
我们证明，不同的临床可用 MRI DSC 灌注软件包在区分标准治疗后高级别胶质瘤的肿瘤进展与假性进展时，会产生明显不同的 rCBV 截断值。在面临这一临床挑战时，医生可能希望在机构层面上确定其灌注软件包的独特价值，以最大限度地提高诊断准确性。此外，结合目前 DSC 灌注推荐的实施，将提高多中心的可比性。
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