Prospective comparative diagnostic accuracy evaluation of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) MR perfusion in differentiating tumor recurrence from radiation necrosis in treated high-grade gliomas.
Brain
/ diagnostic imaging
Brain Neoplasms
/ diagnostic imaging
Contrast Media
Diagnosis, Differential
Female
Glioma
/ diagnostic imaging
Humans
Image Enhancement
/ methods
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Necrosis
/ diagnostic imaging
Neoplasm Recurrence, Local
/ diagnostic imaging
Prospective Studies
Radiation Injuries
/ diagnostic imaging
Reproducibility of Results
DCE
DSC
comparison
diagnostic accuracy
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
12
09
2018
revised:
04
12
2018
accepted:
05
12
2018
pubmed:
8
1
2019
medline:
22
9
2020
entrez:
8
1
2019
Statut:
ppublish
Résumé
The appearance of a new enhancing lesion after surgery and chemoradiation for high-grade glioma (HGG) presents a common diagnostic dilemma. Histopathological analysis remains the reference standard in this situation. To prospectively compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) in differentiating tumor recurrence (TR) from radiation necrosis (RN). Prospective diagnostic accuracy study. In all, 98 consecutive treated HGG patients with new enhancing lesion. We excluded 32 patients due to inadequate follow-up or technical limitation. 3 T DCE and DSC MR. Histogram and hot-spot analysis of cerebral blood volume (CBV), corrected CBV, K Mann-Whitney U-tests, receiver operating characteristic (ROC) curve, and logistic regression analysis. A total of 68 lesions were included. There were 37 TR, 28 RN, and three lesions with equal proportions of TR and RN. TR had significantly higher CBV, corrected CBV, CBV ratio, corrected CBV ratio, AUC ratio, and Vp ratio (P < 0.05) than RN on hot-spot analysis. CBV had the highest diagnostic accuracy (AUROC 0.71). On histogram analysis, TR had higher CBV and corrected CBV maximal value compared with RN (P = 0.006, AUROC = 0.70). Only CBV on hot-spot analysis remained significant after correction for multiple comparison, with no significant improvement in diagnostic accuracy when using a combination of parameters (AUROC 0.71 vs. 0.76, P = 0.24). DSC-derived CBV is the most accurate perfusion parameter in differentiating TR and RN. DSC and DCE-derived parameters reflecting the blood volume in an enhancing lesion are more accurate than the DCE-derived parameter K 1 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2019;50:573-582.
Sections du résumé
BACKGROUND
The appearance of a new enhancing lesion after surgery and chemoradiation for high-grade glioma (HGG) presents a common diagnostic dilemma. Histopathological analysis remains the reference standard in this situation.
PURPOSE
To prospectively compare the diagnostic accuracy of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) in differentiating tumor recurrence (TR) from radiation necrosis (RN).
STUDY TYPE
Prospective diagnostic accuracy study.
POPULATION
In all, 98 consecutive treated HGG patients with new enhancing lesion. We excluded 32 patients due to inadequate follow-up or technical limitation.
FIELD STRENGTH/SEQUENCE
3 T DCE and DSC MR.
ASSESSMENT
Histogram and hot-spot analysis of cerebral blood volume (CBV), corrected CBV, K
STATISTICAL TESTS
Mann-Whitney U-tests, receiver operating characteristic (ROC) curve, and logistic regression analysis.
RESULTS
A total of 68 lesions were included. There were 37 TR, 28 RN, and three lesions with equal proportions of TR and RN. TR had significantly higher CBV, corrected CBV, CBV ratio, corrected CBV ratio, AUC ratio, and Vp ratio (P < 0.05) than RN on hot-spot analysis. CBV had the highest diagnostic accuracy (AUROC 0.71). On histogram analysis, TR had higher CBV and corrected CBV maximal value compared with RN (P = 0.006, AUROC = 0.70). Only CBV on hot-spot analysis remained significant after correction for multiple comparison, with no significant improvement in diagnostic accuracy when using a combination of parameters (AUROC 0.71 vs. 0.76, P = 0.24).
DATA CONCLUSION
DSC-derived CBV is the most accurate perfusion parameter in differentiating TR and RN. DSC and DCE-derived parameters reflecting the blood volume in an enhancing lesion are more accurate than the DCE-derived parameter K
LEVEL OF EVIDENCE
1 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2019;50:573-582.
Substances chimiques
Contrast Media
0
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
573-582Informations de copyright
© 2019 International Society for Magnetic Resonance in Medicine.