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

• Published in: Neuroradiology Vol. 52; no. 4; pp. 297 - 306
• Main Authors: Matsusue, Eiji, Fink, James R., Rockhill, Jason K., Ogawa, Toshihide, Maravilla, Kenneth R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2010; Springer; Springer Nature B.V
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Biological and medical sciences; Blood Volume; Bone marrow, stem cells transplantation. Graft versus host reaction; Brain - metabolism; Brain - pathology; Brain - radiation effects; Brain Neoplasms - diagnosis; Brain Neoplasms - pathology; Brain Neoplasms - radiotherapy; Cerebrovascular Circulation; Choline - metabolism; Creatine - metabolism; Diagnostic Neuroradiology; Diagnostic tests; Diffusion Magnetic Resonance Imaging - methods; Disease Progression; Female; Follow-Up Studies; Glioma - diagnosis; Glioma - pathology; Glioma - radiotherapy; Humans; Imaging; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Spectroscopy - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - pathology; Nervous system; Neurology; Neuroradiology; Neurosciences; Neurosurgery; NMR; Nuclear magnetic resonance; Perfusion Imaging - methods; Pilot Projects; Radiation; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Retrospective Studies; Spectrum analysis; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Recurrence; Glioma; MR perfusion; Radiation; MR diffusion; MR spectroscopy; Nervous system diseases; Radiodiagnosis; NMR spectrometry; Nuclear magnetic resonance imaging; Central nervous system disease; Tumor; Diffusion
• ISSN: 0028-3940; 1432-1920; 1432-1920
• DOI: 10.1007/s00234-009-0613-9

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.