Influence of arterial transit time delays on the differentiation between tumor progression and pseudoprogression in glioblastoma by arterial spin labeling magnetic resonance imaging.

Autor: van Dorth D; C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Jiang FY; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Radiology, HagaZiekenhuis, Den Haag, The Netherlands., Schmitz-Abecassis B; C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.; Medical Delta, Delft, The Netherlands., Croese RJI; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands., Taphoorn MJB; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands., Smits M; Medical Delta, Delft, The Netherlands.; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.; Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Koekkoek JAF; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands., Dirven L; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands., de Bresser J; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., van Osch MJP; C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.; Medical Delta, Delft, The Netherlands.
Jazyk: angličtina
Zdroj: NMR in biomedicine [NMR Biomed] 2024 Sep; Vol. 37 (9), pp. e5166. Date of Electronic Publication: 2024 Apr 23.
DOI: 10.1002/nbm.5166
Abstrakt: Arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) have shown potential for differentiating tumor progression from pseudoprogression. For pseudocontinuous ASL with a single postlabeling delay, the presence of delayed arterial transit times (ATTs) could affect the evaluation of ASL-MRI perfusion data. In this study, the influence of ATT artifacts on the perfusion assessment and differentiation between tumor progression and pseudoprogression were studied. This study comprised 66 adult patients (mean age 60 ± 13 years; 40 males) with a histologically confirmed glioblastoma who received postoperative radio (chemo)therapy. ASL-MRI and DSC-MRI scans were acquired at 3 months postradiotherapy as part of the standard clinical routine. These scans were visually scored regarding (i) the severity of ATT artifacts (%) on the ASL-MRI scans only, scored by two neuroradiologists; (ii) perfusion of the enhancing tumor lesion; and (iii) radiological evaluation of tumor progression versus pseudoprogression by one neuroradiologist. The final outcome was based on combined clinical and radiological follow-up until 9 months postradiotherapy. ATT artifacts were identified in all patients based on the mean scores of two raters. A significant difference between the radiological evaluation of ASL-MRI and DSC-MRI was observed only for ASL images with moderate ATT severity (30%-65%). The perfusion assessment showed ASL-MRI tending more towards hyperperfusion than DSC-MRI in the case of moderate ATT artifacts. In addition, there was a significant difference between the prediction of tumor progression with ASL-MRI and the final outcome in the case of severe ATT artifacts (McNemar test, p = 0.041). Despite using ASL imaging parameters close to the recommended settings, ATT artifacts frequently occur in patients with treated brain tumors. Those artifacts could hinder the radiological evaluation of ASL-MRI data and the detection of true disease progression, potentially affecting treatment decisions for patients with glioblastoma.
(© 2024 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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