New Subependymal Enhancement After Radiation Therapy in High-Grade Glioma: Utilizing Morphological Features and DSC Perfusion MRI in Differentiate Progression and Post-Radiation Changes.
glioblastoma
leptomeningeal disease
perfusion MRI
radiation‐induced effect
subependymal enhancement
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:
05 Sep 2024
05 Sep 2024
Historique:
revised:
08
08
2024
received:
15
05
2024
accepted:
09
08
2024
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
6
9
2024
Statut:
aheadofprint
Résumé
The specific patterns of subependymal enhancement (SE) that frequently occur as radiation-induced changes in high-grade gliomas following radiotherapy are often overlooked. Perfusion MRI may offer a diagnostic clue. To distinguish between radiation-induced SE and progression in adult high-grade diffuse gliomas after standard treatment. Retrospective. Ninety-four consecutive high-grade diffuse glioma patients (mean age, 55 ± 14 years; 54 [57.4%] males) with new SE identified in follow-up MRI after completion of surgery plus chemoradiation: progression (N = 74) vs. regression (N = 20). 3 T, gradient-echo dynamic susceptibility contrast-enhanced MRI, 3D gradient-echo contrast-enhanced T1-weighted imaging. To differentiate between radiation changes and progression in SE evaluation, multivariable logistic regression was performed using significant variables among SE appearance interval, IDH mutation, morphological features, and rCBV. Cox regression was performed to predict the tumor progression. For the added value of the rCBV, a log-rank test was conducted between the multivariable logistic regression models with and without the rCBV. Logistic regression, Cox regression, receiver operating characteristic analysis, log-rank test. 38.3% (36/94) patients had first specific SE (9.2 ± 9.5 months after surgery), which disappeared in 21.3% (20/94) after 5.8 ± 5.8 months after initial appearance on post-radiation MRI. IDH mutation, elongated, small lesions with lower rCBV tended to regress: IDH mutation, elongation, diameter, and rCBV_p95; odds ratio, 0.32, 1.92, 1.70, and 2.47, respectively. Qualitative evaluation of shape revealed that thin and curvilinear-shaped SE tended to regress, indicating a significant correlation with quantitative shape features (r = 0.31). In Cox regression, rCBV and lesion shape were significant (hazard ratio = 1.09 and 0.54, respectively). For sub-centimeter lesions, the rCBV showed added value in predicting outcomes (area under the curve, 0.873 vs. 0.836; log-rank test). Smaller, elongated lesions with lower rCBV and IDH mutation are associated with regression when differentiating radiation changes from progression in high-grade glioma with post-radiotherapy SE. 3 TECHNICAL EFFICACY: Stage 2.
Sections du résumé
BACKGROUND
BACKGROUND
The specific patterns of subependymal enhancement (SE) that frequently occur as radiation-induced changes in high-grade gliomas following radiotherapy are often overlooked. Perfusion MRI may offer a diagnostic clue.
PURPOSE
OBJECTIVE
To distinguish between radiation-induced SE and progression in adult high-grade diffuse gliomas after standard treatment.
STUDY TYPE
METHODS
Retrospective.
POPULATION
METHODS
Ninety-four consecutive high-grade diffuse glioma patients (mean age, 55 ± 14 years; 54 [57.4%] males) with new SE identified in follow-up MRI after completion of surgery plus chemoradiation: progression (N = 74) vs. regression (N = 20).
FIELD STRENGTH/SEQUENCE
UNASSIGNED
3 T, gradient-echo dynamic susceptibility contrast-enhanced MRI, 3D gradient-echo contrast-enhanced T1-weighted imaging.
ASSESSMENT
RESULTS
To differentiate between radiation changes and progression in SE evaluation, multivariable logistic regression was performed using significant variables among SE appearance interval, IDH mutation, morphological features, and rCBV. Cox regression was performed to predict the tumor progression. For the added value of the rCBV, a log-rank test was conducted between the multivariable logistic regression models with and without the rCBV.
STATISTICAL TESTS
METHODS
Logistic regression, Cox regression, receiver operating characteristic analysis, log-rank test.
RESULTS
RESULTS
38.3% (36/94) patients had first specific SE (9.2 ± 9.5 months after surgery), which disappeared in 21.3% (20/94) after 5.8 ± 5.8 months after initial appearance on post-radiation MRI. IDH mutation, elongated, small lesions with lower rCBV tended to regress: IDH mutation, elongation, diameter, and rCBV_p95; odds ratio, 0.32, 1.92, 1.70, and 2.47, respectively. Qualitative evaluation of shape revealed that thin and curvilinear-shaped SE tended to regress, indicating a significant correlation with quantitative shape features (r = 0.31). In Cox regression, rCBV and lesion shape were significant (hazard ratio = 1.09 and 0.54, respectively). For sub-centimeter lesions, the rCBV showed added value in predicting outcomes (area under the curve, 0.873 vs. 0.836; log-rank test).
DATA CONCLUSION
CONCLUSIONS
Smaller, elongated lesions with lower rCBV and IDH mutation are associated with regression when differentiating radiation changes from progression in high-grade glioma with post-radiotherapy SE.
EVIDENCE LEVEL
METHODS
3 TECHNICAL EFFICACY: Stage 2.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : National Research Foundation of Korea
ID : 2020R1A2C2008949
Organisme : National Research Foundation of Korea
ID : RS-2023-00207783
Organisme : National Research Foundation of Korea
ID : RS-2023-00224382
Organisme : National Research Foundation of Korea
ID : RS-2023-00242754
Organisme : Samsung
ID : SRFC-IT2201-04
Organisme : Institute for Basic Science
ID : IBS-R006-D1
Organisme : Seoul National University Hospital
ID : 1820230040
Informations de copyright
© 2024 International Society for Magnetic Resonance in Medicine.
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