Clinical Research Papers:
Combined use of susceptibility weighted magnetic resonance imaging sequences and dynamic susceptibility contrast perfusion weighted imaging to improve the accuracy of the differential diagnosis of recurrence and radionecrosis in high-grade glioma patients
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Tae-Hyung Kim1, Tae Jin Yun1,2, Chul-Kee Park3, Tae Min Kim4, Ji-Hoon Kim1,2, Chul-Ho Sohn1,2, Jae Kyung Won5, Sung-Hye Park5, Il Han Kim6 and Seung Hong Choi1,2,7
1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
2 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
3 Department of Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
4 Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
5 Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
6 Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
7 Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea
Seung Hong Choi, email:
Keywords: magnetic resonance imaging, radionecrosis, recurrence, susceptibility-weighted magnetic resonance imaging sequences, dynamic susceptibility contrast perfusion-weighted imaging
Received: June 30, 2016 Accepted: October 28, 2016 Published: November 03, 2016
Purpose was to assess predictive power for overall survival (OS) and diagnostic performance of combination of susceptibility-weighted MRI sequences (SWMRI) and dynamic susceptibility contrast (DSC) perfusion-weighted imaging (PWI) for differentiation of recurrence and radionecrosis in high-grade glioma (HGG). We enrolled 51 patients who underwent radiation therapy or gamma knife surgeryfollowed by resection for HGG and who developed new measurable enhancement more than six months after complete response. The lesions were confirmed as recurrence (n = 32) or radionecrosis (n = 19). The mean and each percentile value from cumulative histograms of normalized CBV (nCBV) and proportion of dark signal intensity on SWMRI (proSWMRI, %) within enhancement were compared. Multivariate regression was performed for the best differentiator. The cutoff value of best predictor from ROC analysis was evaluated. OS was determined with Kaplan-Meier method and log-rank test. Recurrence showed significantly lower proSWMRI and higher mean nCBV and 90th percentile nCBV (nCBV90) than radionecrosis. Regression analysis revealed both nCBV90 and proSWMRI were independent differentiators. Combination of nCBV90 and proSWMRI achieved 71.9% sensitivity (23/32), 100% specificity (19/19) and 82.3% accuracy (42/51) using best cut-off values (nCBV90 > 2.07 and proSWMRI≤15.76%) from ROC analysis. In subgroup analysis, radionecrosis with nCBV > 2.07 (n = 5) showed obvious hemorrhage (proSWMRI > 32.9%). Patients with nCBV90 > 2.07 and proSWMRI≤15.76% had significantly shorter OS. In conclusion, compared with DSC PWI alone, combination of SWMRI and DSC PWI have potential to be prognosticator for OS and lower false positive rate in differentiation of recurrence and radionecrosis in HGG who develop new measurable enhancement more than six months after complete response.
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