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Longitudinal, leakage corrected and uncorrected rCBV during the first-line treatment of glioblastoma: a prospective study

  • Clinical Study
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Abstract

Purpose

Dynamic susceptibility contrast (DSC) MR-perfusion is becoming a standard of care for the monitoring of glioblastoma. Yet, technical standards are lacking and measurements without leakage correction are still common. Also, data on leakage corrected measurements during stable disease is scarce. In this study we hypothesized that basic leakage correction would significantly enhance data quality during stable disease and improve progress detection. We furthermore investigated whether longitudinal data could increase diagnostic performance.

Methods

Patients with histologically proven glioblastoma undergoing first-line therapy were prospectively recruited. We conducted DSC perfusion measurements without prebolus administration in 6-week intervals from the end of radiotherapy until progression. Maximum relative cerebral volume values (rCBVmax) with and without leakage correction were calculated using Philips IntelliSpace®.

Results

We recruited 16 patients and conducted 82 MRI scans with a mean follow up of 7.2 month. During stable disease, corrected rCBVmax was significantly more stable than uncorrected rCBVmax. Detection of progression with a rCBVmax cutoff was better for corrected (specificity 86%) than for uncorrected rCBVmax (specificity 41%). Interestingly, the increase of corrected rCBVmax upon progression also had a good diagnostic performance with a combination of both cutoffs delivering the best result (sensitivity/specificity 89%/93%).

Conclusion

Corrected rCBVmax supports the imaging finding of a stable disease and large increases during longitudinal observation support the diagnosis of tumor progression. rCBV values without prebolus or leakage correction are not reliable to monitor glioblastomas. Further studies to investigate the value of longitudinal rCBV dynamics for the differentiation of real tumor progression from pseudoprogression are warranted.

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Acknowledgements

We thank our medical technical radiology assistants who participated in performing the MRI scans for this study.

Funding

There was no funding for this study.

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Authors and Affiliations

  1. Institute of Neuroradiology, University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Eike Steidl & Elke Hattingen

  2. Department of Radiology, Neuroradiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Eike Steidl, Mathias Müller, Andreas Müller & Elke Hattingen

  3. German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany

    Eike Steidl & Elke Hattingen

  4. Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Ulrich Herrlinger

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  1. Eike Steidl
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  4. Ulrich Herrlinger
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Correspondence to Eike Steidl.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Ethics Committee of the Medical Faculty of the University of Bonn, Reference: Lfd.Nr. 349/14) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Steidl, E., Müller, M., Müller, A. et al. Longitudinal, leakage corrected and uncorrected rCBV during the first-line treatment of glioblastoma: a prospective study. J Neurooncol 144, 409–417 (2019). https://doi.org/10.1007/s11060-019-03244-6

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  • DOI: https://doi.org/10.1007/s11060-019-03244-6

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