Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Added Value of Contrast Leakage Information over the CBV Value of DSC Perfusion MRI to Differentiate between Pseudoprogression and True Progression after Concurrent Chemoradiotherapy in Glioblastoma Patients

  • Pak, Elena (Department of Radiology, Seoul National University Hospital) ;
  • Choi, Seung Hong (Department of Radiology, Seoul National University Hospital) ;
  • Park, Chul-Kee (Department of Neurosurgery and Biomedical Research Institute, Seoul National University Hospital) ;
  • Kim, Tae Min (Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital) ;
  • Park, Sung-Hye (Department of Pathology, Seoul National University Hospital) ;
  • Won, Jae-Kyung (Department of Pathology, Seoul National University Hospital) ;
  • Lee, Joo Ho (Department of Radiation Oncology and Cancer Research Institute, Seoul National University Hospital) ;
  • Lee, Soon-Tae (Department of Neurology, Seoul National University Hospital) ;
  • Hwang, Inpyeong (Department of Radiology, Seoul National University Hospital) ;
  • Yoo, Roh-Eul (Department of Radiology, Seoul National University Hospital) ;
  • Kang, Koung Mi (Department of Radiology, Seoul National University Hospital) ;
  • Yun, Tae Jin (Department of Radiology, Seoul National University Hospital)
  • Received : 2021.10.04
  • Published : 2022.03.30
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Abstract

Purpose: To evaluate whether the added value of contrast leakage information from dynamic susceptibility contrast magnetic resonance imaging (DSC MRI) is a better prognostic imaging biomarker than the cerebral blood volume (CBV) value in distinguishing true progression from pseudoprogression in glioblastoma patients. Materials and Methods: Forty-nine glioblastoma patients who had undergone MRI after concurrent chemoradiotherapy with temozolomide were enrolled in this retrospective study. Twenty features were extracted from the normalized relative CBV (nCBV) and extraction fraction (EF) map of the contrast-enhancing region in each patient. After univariable analysis, we used multivariable stepwise logistic regression analysis to identify significant predictors for differentiating between pseudoprogression and true progression. Receiver operating characteristic (ROC) analysis was employed to determine the best cutoff values for the nCBV and EF features. Finally, leave-one-out cross-validation was used to validate the best predictor in differentiating between true progression and pseudoprogression. Results: Multivariable stepwise logistic regression analysis showed that MGMT (O6-methylguanine-DNA methyltransferase) and EF max were independent differentiating variables (P = 0.004 and P = 0.02, respectively). ROC analysis yielded the best cutoff value of 95.75 for the EF max value for differentiating the two groups (sensitivity, 61%; specificity, 84.6%; AUC, 0.681 ± 0.08; 95% CI, 0.524-0.837; P = 0.03). In the leave-one-out cross-validation of the EF max value, the cross-validated values for predicting true progression and pseudoprogression accuracies were 69.4% and 71.4%, respectively. Conclusion: We demonstrated that contrast leakage information parameter from DSC MRI showed significance in differentiating true progression from pseudoprogression in glioblastoma patients.

Keywords

Acknowledgement

This study was supported by a grant from the Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs (HI16C1111), by the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2016M3C7A1914002), by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C2008949 and NRF-2020R1A4A1018714), by Creative-Pioneering Researchers Program through Seoul National University (SNU), and by the Institute for Basic Science (IBS-R006-A1).

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