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Increased signal intensity within glioblastoma resection cavities on fluid-attenuated inversion recovery imaging to detect early progressive disease in patients receiving radiotherapy with concomitant temozolomide therapy

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Our study tested the diagnostic accuracy of increased signal intensity (SI) within FLAIR MR images of resection cavities in differentiating early progressive disease (ePD) from pseudoprogression (PsP) in patients with glioblastoma treated with radiotherapy with concomitant temozolomide therapy.

Methods

In this retrospective study approved by our Institutional Review Board, we evaluated the records of 122 consecutive patients with partially or totally resected glioblastoma. Region of interest (ROI) analysis assessed 33 MR examinations from 11 subjects with histologically confirmed ePD and 37 MR examinations from 14 subjects with PsP (5 histologically confirmed, 9 clinically diagnosed). After applying an N4 bias correction algorithm to remove B0 field distortion and to standardize image intensities and then normalizing the intensities based on an ROI of uninvolved white matter from the contralateral hemisphere, the mean intensities of the ROI from within the resection cavities were calculated. Measures of diagnostic performance were calculated from the receiver operating characteristic (ROC) curve using the threshold intensity that maximized differentiation. Subgroup analysis explored differences between the patients with biopsy-confirmed disease.

Results

At an optimal threshold intensity of 2.9, the area under the ROC curve (AUROC) for FLAIR to differentiate ePD from PsP was 0.79 (95% confidence interval 0.686–0.873) with a sensitivity of 0.818 and specificity of 0.694. The AUROC increased to 0.86 when only the patients with biopsy-confirmed PsP were considered.

Conclusions

Increased SI within the resection cavity of FLAIR images is not a highly specific sign of ePD in glioblastoma patients treated with the Stupp protocol.

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Correspondence to Bradley J. Erickson.

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Funding

This research was partially funded by NCI CA160045.

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The authors declare that they have no conflict of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Perry, L.A., Korfiatis, P., Agrawal, J.P. et al. Increased signal intensity within glioblastoma resection cavities on fluid-attenuated inversion recovery imaging to detect early progressive disease in patients receiving radiotherapy with concomitant temozolomide therapy. Neuroradiology 60, 35–42 (2018). https://doi.org/10.1007/s00234-017-1941-9

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  • DOI: https://doi.org/10.1007/s00234-017-1941-9

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