Post-gadolinium 3-dimensional spatial, surface, and structural characteristics of glioblastomas differentiate pseudoprogression from true tumor progression



Pseudoprogression is often indistinguishable from true tumor progression on conventional 2-dimensional (2D) MRI in glioblastoma multiforme (GBM) patients. The aim of this study was to determine the association between post-gadolinium 3-dimensional (3D) characteristics and clinical state in GBM patients.


Standardized 3D brain MRI studies were performed, and contrast enhancing portions of each tumor were segmented and analyzed, blinded to clinical state, using principal component analysis (PCA), medial axis transformation (MAT), and coverage analysis. Associations between the 3D characteristics of the post-gadolinium enhanced regions and the clinical status of patients were performed.


A total of 15 GBM patients [male: 11 (73%); median age (range): 62 years (36–72)] with a median disease duration of 6 months (range 2–24 months) were studied cross-sectionally with 6 (40%) patients identified with tumor progression. Post-gadolinium features corresponding to the group with progressive disease exhibited a more spherical and symmetric shape relative to their stable counterparts (p = 0.005). The predictive value of a more uniformly full post-gadolinium enhanced shell to clinical progression was determined with a sensitivity of 66.7% (95% CI 29.9–92.5), specificity of 100% (54.1–100), and PPV of 100% (p = 0.028, 2-tailed Fisher’s exact test). There did not appear to be an association between the thickness of the contrast enhanced shell to clinical state.


The application of 3D technology with post-gadolinium imaging data may inform healthcare providers with new insights into disease states based on spatial, surface, and structural patterns.

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We thank all patients who participated in this research effort.

Data availabilty

The datasets generated and analysed during this study are available from the corresponding author on reasonable request.

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Corresponding author

Correspondence to Darin T. Okuda.

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Conflict of interest

D.O. received lecture fees from Acorda Therapeutics, Genentech, Genzyme, and Teva, advisory and consulting fees from Celgene, EMD Serono, Genentech, Genzyme, and Novartis and research support from Biogen. M.H., E.P., A.W., M.M., Y.W., T.S., M.P, and X.G. report no disclosures.

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Informed consent was obtained from all study participants.

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Hansen, M.R., Pan, E., Wilson, A. et al. Post-gadolinium 3-dimensional spatial, surface, and structural characteristics of glioblastomas differentiate pseudoprogression from true tumor progression. J Neurooncol 139, 731–738 (2018).

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  • Glioblastoma multiforme
  • 3-Dimensional
  • MRI
  • Contrast enhancement
  • Pseudoprogression