방사선의학 웹진

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Abstract

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. 

Author information

Kim TH1, Yun TJ1,2, Park CK3, Kim TM4, Kim JH1,2, Sohn CH1,2, Won JK5, Park SH5, Kim IH6, Choi SH1,2,7.​

1Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.

2Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.

3Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.

4Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.

5Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.

6Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.

7Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea.