Transcript ASL - Rackcdn.com

Disclosures
*No financial disclosure
Introduction
• Glioblastoma (GBM) is the most common primary malignant brain
tumor in adults.
• The dilemma of true progression (PD) or pseudo-progression(PsP) of
glioblastoma (GBM) is often encountered by clinicians particularly after
the incorporation of immunotherapy and concurrent chemoradiotherapy
(CRT) following surgical resection of the tumor.
• Conventional MRI can’t differentiate between true progression and
pseudo-progression.
Purpose
• To evaluate the predictive value of Magnetic Resonance Spectroscopy
(MRS), magnetic resonance perfusion (MRP) techniques namely dynamic
susceptibility contrast (DSC), Dynamic contrast enhanced (DCE) imaging
analysis and arterial spin labeling (ASL) in discriminating Pseudoprogression (PsP) from true progression (PD) in Glioblastoma (GBM)
patients .
Methods and materials
Patients demographics
Age range from 27 to 92 years old
Average age = 54
32
51
Males
Females
Questionnaire data and image characteristics evaluation
Standard advanced brain
tumor imaging
Conventional MRI
-Axial DTI
-Axial T1
-Axial T2
-Axial FLAIR
-Axial T1 + contrast
-T2*
Advanced Brain Tumor
Imaging
-ASL
-DCE
-DSC
-MRS
Results
Results of imaging modality
T1+ Contrast
DCE
DSC
ASL
MRS
Malignant
PsP
Malignant
31
18
PsP
15
19
Malignant
43
24
PsP
0
12
Malignant
26
19
PsP
5
10
Malignant
11
8
PsP
1
10
Malignant
27
19
PsP
6
12
Results
Sensitivity
Specificity
PPV
NPV
Accuracy
51%
63.2%
55.88%
60%
64.18%
100%
69.6%
57.78%
66.67%
60%
T1 +
contrast
67%
DCE
100%
33.3%
DSC
83.87%
34.48%
91.67%
55.56%
57.89%
90.9%
70%
81.8%
38.7%
58.7%
66.67%
60.9%
ASL
MRS
*Excluded due to artifacts
** 53 cases didn’t have ASL
Number
of cases
excluded*
0
4
23
53**
19
Conclusion
• DCE was able to identify 100% of cases with true progression. However,
specificity was low (33.3%).
• ASL was the modality that had the best overall sensitivity (91.67%) and
specificity ( 55.6%) in differentiating recurrent GBM from pseudoprogression.
References
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recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies.
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3- Young RJ, Gupta A, Shah AD, et al. MRI perfusion in determining pseudoprogression
in patients with glioblastoma. Clinical imaging. 2013 Jan-Feb;37(1):41-9
4- Sawlani V, Taylor R, Rowley K, Redfern R, Martin J, Poptani H. Magnetic Resonance
Spectroscopy for Differentiating Pseudo-Progression from True Progression in GBM on
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