Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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True Progression versus Pseudoprogression in the Treatment of Glioblastomas: A Comparison Study of Normalized Cerebral Blood Volume and Apparent Diffusion Coefficient by Histogram Analysis

  • Song, Yong Sub (Department of Radiology, Seoul National University College of Medicine) ;
  • Choi, Seung Hong (Department of Radiology, Seoul National University College of Medicine) ;
  • Park, Chul-Kee (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Yi, Kyung Sik (Department of Radiology, Seoul National University College of Medicine) ;
  • Lee, Woong Jae (Department of Radiology, Seoul National University College of Medicine) ;
  • Yun, Tae Jin (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, Tae Min (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Lee, Se-Hoon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Ji-Hoon (Department of Radiology, Seoul National University College of Medicine) ;
  • Sohn, Chul-Ho (Department of Radiology, Seoul National University College of Medicine) ;
  • Park, Sung-Hye (Department of Pathology, Seoul National University College of Medicine) ;
  • Kim, Il Han (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Jahng, Geon-Ho (Department of Radiology, School of Medicine of Kyung Hee University) ;
  • Chang, Kee-Hyun (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2012.12.16
  • Accepted : 2013.04.04
  • Published : 2013.07.01
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Abstract

Objective: The purpose of this study was to differentiate true progression from pseudoprogression of glioblastomas treated with concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ) by using histogram analysis of apparent diffusion coefficient (ADC) and normalized cerebral blood volume (nCBV) maps. Materials and Methods: Twenty patients with histopathologically proven glioblastoma who had received CCRT with TMZ underwent perfusion-weighted imaging and diffusion-weighted imaging (b = 0, 1000 $sec/mm^2$). The corresponding nCBV and ADC maps for the newly visible, entirely enhancing lesions were calculated after the completion of CCRT with TMZ. Two observers independently measured the histogram parameters of the nCBV and ADC maps. The histogram parameters between the true progression group (n = 10) and the pseudoprogression group (n = 10) were compared by use of an unpaired Student's t test and subsequent multivariable stepwise logistic regression analysis to determine the best predictors for the differential diagnosis between the two groups. Receiver operating characteristic analysis was employed to determine the best cutoff values for the histogram parameters that proved to be significant predictors for differentiating true progression from pseudoprogression. Intraclass correlation coefficient was used to determine the level of inter-observer reliability for the histogram parameters. Results: The 5th percentile value (C5) of the cumulative ADC histograms was a significant predictor for the differential diagnosis between true progression and pseudoprogression (p = 0.044 for observer 1; p = 0.011 for observer 2). Optimal cutoff values of $892{\times}10^{-6}mm^2/sec$ for observer 1 and $907{\times}10^{-6}mm^2/sec$ for observer 2 could help differentiate between the two groups with a sensitivity of 90% and 80%, respectively, a specificity of 90% and 80%, respectively, and an area under the curve of 0.880 and 0.840, respectively. There was no other significant differentiating parameter on the nCBV histograms. Inter-observer reliability was excellent or good for all histogram parameters (intraclass correlation coefficient range: 0.70-0.99). Conclusion: The C5 of the cumulative ADC histogram can be a promising parameter for the differentiation of true progression from pseudoprogression of newly visible, entirely enhancing lesions after CCRT with TMZ for glioblastomas.

Keywords

References

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