Diffusion and Perfusion MRI to Differentiate Treatment-Related Changes Including Pseudoprogression from Recurrent Tumors in High-Grade Gliomas with Histopathologic Evidence

• DOI: 10.3174/ajnr.a4218
• Publication Date: 2015-01-16T03:50:00Z
• Authors: A.J. Prager; N. Martinez; K. Beal; A. Omuro; Z. Zhang; R.J. Young
• Keywords: Histopathology

<h3>BACKGROUND AND PURPOSE:</h3> Treatment-related changes and recurrent tumors often have overlapping features on conventional MR imaging. The purpose of this study was to assess the utility DWI DSC perfusion imaging alone in combination differentiate treatment-related effects high-grade gliomas. <h3>MATERIALS METHODS:</h3> We retrospectively identified 68 consecutive patients with gliomas treated by surgical resection followed radiation therapy temozolomide, who then developed increasing enhancing mass lesions indeterminate for versus tumor. All were diagnosed histopathology at repeat resection. ROI analysis performed lesion ADC maps. Measurements made a 2D single slice recorded as ADC_Lesion rCBV_Lesion, measurements most abnormal small fixed diameter ADC_ROI rCBV_ROI. Statistical Wilcoxon rank sum tests <i>P</i> = .05. <h3>RESULTS:</h3> Ten (14.7%) had changes, while 58 (85.3%) tumor only (<i>n</i> 19) or mixed treatment effect 39). showed higher than (<i>P</i> .003). revealed lower relative cerebral blood volume (rCBV)_Lesion rCBV_ROI .003 .011, respectively). Subanalysis suspected pseudoprogression also .001) rCBV_Lesion .028) .032) changes. Applying combined model did not outperform either rCBV metric alone. <h3>CONCLUSIONS:</h3> diffusion Similar correlations found pseudoprogression.