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Uninterpretable Dynamic Susceptibility Contrast-Enhanced Perfusion MR Images in Patients with Post-Treatment Glioblastomas: Cross-Validation of Alternative Imaging Options.
- Source :
-
PloS one [PLoS One] 2015 Aug 21; Vol. 10 (8), pp. e0136380. Date of Electronic Publication: 2015 Aug 21 (Print Publication: 2015). - Publication Year :
- 2015
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Abstract
- Purpose: The purpose of this study was to evaluate the accuracy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) perfusion MR imaging for distinguishing tumor recurrence from post-treatment effect as alternatives to dynamic-susceptibility contrast-enhanced (DSC) perfusion MR imaging when the DSC image is uninterpretable.<br />Materials and Methods: This retrospective study was approved by our institutional review board. Seventy one post-treatment glioblastoma patients who showed enlarged contrast-enhancing lesions on follow-up MR images after concurrent chemoradiotherapy and uninterpretable DSC images for corresponding enhancing lesions, underwent additional DWI and DCE MR imaging. The primary outcome was the frequency of interpretable DWI and DCE MR cases in these 71 patients. The secondary outcome was the area under the receiver operating characteristic curve (AUC) of DWI and DCE imaging parameters for distinguishing tumor recurrence from post-treatment effect in selected patients with interpretable DWI and DCE images. The imaging parameters were quantified as 10% cumulative histogram cutoff of apparent diffusion coefficient (ADC10) and 90% cumulative histogram cutoff of initial area under the time signal intensity curve (IAUC90). The AUCs were cross-validated by using leave-one-out method.<br />Results: Of the 71 patients, the uninterpretable DSC images were associated with treatment-related hemorrhage within the corresponding enhancing lesions (n = 54, 76.1%) and a near skull base location (n = 17, 23.9%). The frequencies of interpretable DWI and DCE image were 51 (71.8%) and 59 (83.1%) of the 71 cases with uninterpretable DSC images, respectively. Of the 45 selected patients with interpretable DWI and DCE images, the combination of DWI with DCE imaging showed a superior diagnostic performance than DWI or DCE imaging alone for differentiating tumor recurrence from post-treatment effect (cross-validated AUC: 0.78 versus 0.55 and 0.73 for reader 1; cross-validated AUC: 0.78 versus 0.53 and 0.75 for reader 2, respectively). Cross-validated accuracy of the single and combined imaging parameters also showed the highest for the combination of DWI with DCE MR imaging (72.9% for reader 1; 72.5% for reader 2) and the lowest for DWI alone (54.0% for reader 1; 56.4% for reader 2). Inter-reader agreement for DCE imaging was higher than that for DWI (intraclass correlation coefficient: 0.95 versus 0.87).<br />Conclusion: DCE MR imaging could be a superior and more reproducible imaging biomarker than DWI for differentiating tumor recurrence from post-treatment effect in patients with post-treatment glioblastoma when DSC MR images are not interpretable.
- Subjects :
- Adult
Aged
Antineoplastic Agents therapeutic use
Area Under Curve
Brain Neoplasms drug therapy
Brain Neoplasms pathology
Brain Neoplasms radiotherapy
Contrast Media administration & dosage
Female
Glioblastoma drug therapy
Glioblastoma pathology
Glioblastoma radiotherapy
Humans
Image Enhancement
Image Interpretation, Computer-Assisted
Male
Middle Aged
Neoplasm Recurrence, Local drug therapy
Neoplasm Recurrence, Local pathology
Neoplasm Recurrence, Local radiotherapy
ROC Curve
Reproducibility of Results
Retrospective Studies
Brain Neoplasms diagnosis
Diffusion Magnetic Resonance Imaging methods
Gamma Rays therapeutic use
Glioblastoma diagnosis
Neoplasm Recurrence, Local diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 10
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 26296086
- Full Text :
- https://doi.org/10.1371/journal.pone.0136380