Investig Magn Reson Imaging.
2022 Mar;26(1):10-19. 10.13104/imri.2022.26.1.10.
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
- Affiliations
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- 1Department of Radiology, Seoul National University Hospital, Seoul, Korea
- 2Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea
- 3Department of Neurosurgery and Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- 4Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
- 5Department of Pathology, Seoul National University Hospital, Seoul, Korea
- 6Department of Radiation Oncology and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
- 7Department of Neurology, Seoul National University Hospital, Seoul, Korea
- KMID: 2533867
- DOI: http://doi.org/10.13104/imri.2022.26.1.10
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 (O 6 -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.
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