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Distinction between glioma progression and post-radiation change by combined physiologic MR imaging

  • Diagnostic Neuroradiology
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Abstract

Introduction

Magnetic resonance (MR) diffusion-weighted imaging (DWI), dynamic susceptibility contrast-enhanced perfusion imaging (DSC), and MR spectroscopy (MRS) techniques provide specific physiologic information that may distinguish malignant glioma progression from post-radiation change, yet no single technique is completely reliable. We propose a simple, multiparametric scoring system to improve diagnostic accuracy beyond that of each technique alone.

Methods

Fifteen subjects with lesions suspicious for glioma progression following radiation therapy who had also undergone 3-tesla DWI, DSC, and MRS studies of the lesion were retrospectively reviewed. Minimum apparent diffusion coefficient (ADC) ratio, maximum regional cerebral blood volume (rCBV) ratio, and maximum MRS choline/creatine (Cho/Cr) and choline/N-acetyl-aspartate (Cho/NAA) metabolic peak-height ratios were quantified within each lesion. Each parameter (ADC ratio, rCBV ratio, and combined Cho/Cr and Cho/NAA ratios) was scored as either glioma progression (one point) or radiation change (zero point) based upon thresholds derived from our own data. For each lesion, the combined parameters yielded a multiparametric score (0 to 3) for prediction of tumor progression or post-radiation change.

Results

Optimum thresholds for ADC ratio (1.30), rCBV ratio (2.10), and either combined Cho/Cr (1.29) and Cho/NAA (1.06) yielded diagnostic accuracies of 86.7%, 86.7%, and 84.6%, respectively (p < 0.05). A combined multiparametric score threshold of 2 improved diagnostic accuracy to 93.3% (p < 0.05).

Conclusion

In this small series combining 3-T DWI, DSC, and MRS diagnostic results using a simple, multiparametric scoring system has potential to improve overall diagnostic accuracy in distinguishing glioma progression from post-radiation change beyond that of each technique alone.

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Conflict of interest statement

K. Maravilla is a research support speaker and consultant for Bracco and offers research support and is a consultant to Bayer healthcare.

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Authors and Affiliations

  1. Department of Radiology, University of Washington, 1959 NE Pacific, Seattle, WA, 98195, USA

    Eiji Matsusue, James R. Fink & Kenneth R. Maravilla

  2. Department of Radiation Oncology, University of Washington, 1959 NE Pacific, Seattle, WA, 98195, USA

    Jason K. Rockhill

  3. Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan

    Eiji Matsusue & Toshihide Ogawa

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  1. Eiji Matsusue
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  2. James R. Fink
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  3. Jason K. Rockhill
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  4. Toshihide Ogawa
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  5. Kenneth R. Maravilla
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Correspondence to Eiji Matsusue.

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Matsusue, E., Fink, J.R., Rockhill, J.K. et al. Distinction between glioma progression and post-radiation change by combined physiologic MR imaging. Neuroradiology 52, 297–306 (2010). https://doi.org/10.1007/s00234-009-0613-9

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  • DOI: https://doi.org/10.1007/s00234-009-0613-9

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