Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.
Dynapex, LLC, Seoul, Korea.
Eur Radiol. 2024 May;34(5):3061-3073. doi: 10.1007/s00330-023-10324-9. Epub 2023 Oct 18.
To evaluate the added value of MR dynamic susceptibility contrast (DSC)-perfusion-weighted imaging (PWI)-derived tumour microvascular and oxygenation information with cerebral blood volume (CBV) to distinguish pseudoprogression from true progression (TP) in post-treatment glioblastoma.
This retrospective single-institution study included patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma and a newly developed or enlarging measurable contrast-enhancing mass within 12 weeks after concurrent chemoradiotherapy. CBV, capillary transit time heterogeneity (CTH), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO) were obtained from DSC-PWI. Predictors were selected using univariable logistic regression, and performance was measured with adjusted diagnostic odds with tumour volume and area under the curve (AUC) of receiver operating characteristics analysis.
A total of 103 patients were included (mean age, 59.6 years; 59 women), with 67 cases of TP and 36 cases of pseudoprogression. Pseudoprogression exhibited higher CTH (4.0 vs. 3.4, p = .019) and higher OEF (12.7 vs. 10.7, p = .014) than TP, but a similar CBV (1.48 vs. 1.53, p = .13) and CMRO (7.7 vs. 7.3s, p = .598). Independent of tumour volume, both high CTH (adjusted odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.11-2.09, p = .009) and high OEF (adjusted OR 1.17; 95% CI:1.03-1.33, p = .016) were predictors of pseudoprogression. The combination of CTH, OEF, and CBV yielded higher diagnostic performance (AUC 0.71) than CBV alone (AUC 0.65).
High intratumoural capillary transit heterogeneity and high oxygen extraction fraction derived from DSC-PWI have enhanced the diagnostic value of CBV in pseudoprogression of post-treatment IDH-wild type glioblastoma.
In the early post-treatment stage of glioblastoma, pseudoprogression exhibited both high oxygen extraction fraction and high capillary transit heterogeneity and these dynamic susceptibility contrast-perfusion weighted imaging derived parameters have added value in cerebral blood volume-based noninvasive differentiation of pseudoprogression from true progression.
• Capillary transit time heterogeneity and oxygen extraction fraction can be measured noninvasively through processing of dynamic susceptibility contrast imaging. • Pseudoprogression exhibited higher capillary transit time heterogeneity and higher oxygen extraction fraction than true progression. • A combination of cerebral blood volume, capillary transit time heterogeneity, and oxygen extraction fraction yielded the highest diagnostic performance (area under the curve 0.71).
评估磁共振动态对比增强（DSC）-灌注加权成像（PWI）衍生的肿瘤微血管和氧合信息（包括脑血容量 [CBV]）在鉴别治疗后胶质母细胞瘤的假性进展与真性进展（TP）中的附加价值。
本回顾性单中心研究纳入 IDH 野生型胶质母细胞瘤患者，且在同步放化疗后 12 周内出现新发病灶或病灶增大的可测量强化病灶。通过 DSC-PWI 获得 CBV、毛细血管转运时间异质性（CTH）、氧摄取分数（OEF）和脑氧代谢率（CMRO）。采用单变量逻辑回归选择预测因子，并通过调整诊断比值比（OR）与肿瘤体积和受试者工作特征（ROC）曲线下面积（AUC）来评估性能。
共纳入 103 例患者（平均年龄 59.6 岁，59 例女性），其中 67 例为 TP，36 例为假性进展。与 TP 相比，假性进展表现出更高的 CTH（4.0 比 3.4，p=0.019）和 OEF（12.7 比 10.7，p=0.014），但 CBV（1.48 比 1.53，p=0.13）和 CMRO（7.7 比 7.3s，p=0.598）相似。独立于肿瘤体积，高 CTH（调整 OR 1.52；95%置信区间 [CI]：1.11-2.09，p=0.009）和高 OEF（调整 OR 1.17；95% CI：1.03-1.33，p=0.016）都是假性进展的预测因子。与 CBV 相比，CTH、OEF 和 CBV 的组合具有更高的诊断性能（AUC 为 0.71）。
DSC-PWI 衍生的肿瘤内毛细血管转运异质性和高氧摄取分数增加了 CBV 在 IDH 野生型胶质母细胞瘤治疗后假性进展中的诊断价值。
在胶质母细胞瘤治疗后的早期阶段，假性进展表现出高氧摄取分数和高毛细血管转运异质性，这些动态对比增强灌注加权成像衍生参数在基于脑血容量的假性进展与真性进展的无创鉴别中具有附加价值。
通过处理动态对比增强成像，可以无创测量毛细血管转运时间异质性和氧摄取分数。
假性进展的毛细血管转运时间异质性和氧摄取分数高于真性进展。
脑血容量、毛细血管转运时间异质性和氧摄取分数的组合具有最高的诊断性能（AUC 为 0.71）。
