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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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