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Different diagnostic values of imaging parameters to predict pseudoprogression in glioblastoma subgroups stratified by MGMT promoter methylation

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Abstract

Objectives

The aim of this study was to determine whether diffusion and perfusion imaging parameters demonstrate different diagnostic values for predicting pseudoprogression between glioblastoma subgroups stratified by O6-mythylguanine-DNA methyltransferase (MGMT) promoter methylation status.

Methods

We enrolled seventy-five glioblastoma patients that had presented with enlarged contrast-enhanced lesions on magnetic resonance imaging (MRI) one month after completing concurrent chemoradiotherapy and undergoing MGMT promoter methylation testing. The imaging parameters included 10 or 90 % histogram cutoffs of apparent diffusion coefficient (ADC10), normalized cerebral blood volume (nCBV90), and initial area under the time signal-intensity curve (IAUC90). The results of the areas under the receiver operating characteristic curve (AUCs) with cross-validation were compared between MGMT methylation and unmethylation groups.

Results

MR imaging parameters demonstrated a trend toward higher accuracy in the MGMT promoter methylation group than in the unmethylation group (cross-validated AUCs = 0.70–0.95 and 0.56–0.87, respectively). The combination of MGMT methylation status with imaging parameters improved the AUCs from 0.70 to 0.75–0.90 for both readers in comparison with MGMT methylation status alone. The probability of pseudoprogression was highest (95.7 %) when nCBV90 was below 4.02 in the MGMT promoter methylation group.

Conclusions

MR imaging parameters could be stronger predictors of pseudoprogression in glioblastoma patients with the methylated MGMT promoter than in patients with the unmethylated MGMT promoter.

Key Points

• The glioblastoma subgroup was stratified according to MGMT promoter methylation status.

• Diagnostic values of diffusion and perfusion parameters for predicting pseudoprogression were compared.

• Imaging parameters showed higher diagnostic accuracy in the MGMT promoter methylation group.

• Imaging parameters were independent to MGMT promoter methylation status for predicting pseudoprogression.

• Imaging biomarkers might demonstrate different diagnostic values according to MGMT promoter methylation.

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Abbreviations

CCRT:

Concurrent chemoradiotherapy

MR:

Magnetic resonance

CBV:

Cerebral blood volume

ADC:

Apparent diffusion coefficient

MGMT:

O6-mythylguanine-DNA methyltransferase

DWI:

Diffusion-weighted imaging

DSC:

Dynamic susceptibility contrast-enhanced

DCE:

Dynamic contrast-enhanced

IAUC:

Initial area under the time–signal intensity curve

ROC:

Receiver operating characteristic

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Acknowledgments

The scientific guarantor of this publication is Prof. Sang Joon Kim. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant number: NRF-2014R1A2A2A01004937). The Institutional Review Board approved our human study (The Institutional Review Board of Asan Medical Center [http://eirb.amc.seoul.kr]: S2014-2090-0001). Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. The authors thank the Biomedical Imaging Infrastructure, Department of Radiology, Asan Medical Center for the technical support of image processing. Some subjects or cohorts have been previously reported in Park JE, Kim HS, Goh MJ, Kim SJ, Kim JH. Pseudoprogression in patients with glioblastoma: assessment by using volume-weighted voxel-based multiparametric clustering of MR imaging data in an independent test set. Radiology 2015 Jun;275(3):792–802).

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    Authors and Affiliations

    1. Department of Radiology, Catholic Kwandong University College of Medicine, Catholic Kwandong University International St. Mary’s Hospital, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, Republic of Korea

      Ra Gyoung Yoon

    2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Republic of Korea

      Ho Sung Kim, Woo Hyun Shim & Sang Joon Kim

    3. Department of Radiology, Dankook Unversity Hospital, San 16-5, Anseo-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea

      Wooyul Paik

    4. Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Republic of Korea

      Jeong Hoon Kim

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    1. Ra Gyoung Yoon
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    2. Ho Sung Kim
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    Corresponding author

    Correspondence to Ho Sung Kim.

    Additional information

    Ra Gyoung Yoon and Wooyul Paik contributed equally to this work.

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    Yoon, R.G., Kim, H.S., Paik, W. et al. Different diagnostic values of imaging parameters to predict pseudoprogression in glioblastoma subgroups stratified by MGMT promoter methylation. Eur Radiol 27, 255–266 (2017). https://doi.org/10.1007/s00330-016-4346-y

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    • DOI: https://doi.org/10.1007/s00330-016-4346-y

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