Role of Dynamic Susceptibility Contrast Perfusion MRI in Glioma Progression Evaluation

Accurately and quickly differentiating true progression from pseudoprogression in glioma patients is still a challenge. This study aims to explore if dynamic susceptibility contrast- (DSC-) MRI can improve the evaluation of glioma progression. We enrolled 65 glioma patients with suspected gadolinium-enhancing lesion. Longitudinal MRI follow-up (mean 590 days, range: 210–2670 days) or re-operation (n = 3) was used to confirm true progression (n = 51) and pseudoprogression (n = 14). We assessed the diagnostic performance of each MRI variable and the different combinations. Our results showed that the relative cerebral blood volume (rCBV) in the true progression group (1.094, 95%CI: 1.135–1.636) was significantly higher than that of the pseudoprogression group (0.541 ± 0.154) <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mfenced open="(" close=")" separators="|"> <a:mrow> <a:mi>p</a:mi> <a:mo><</a:mo> <a:mn>0.001</a:mn> </a:mrow> </a:mfenced> </a:math> . Among the 18 patients who had serial DSC-MRI, the rCBV of the progression group (0.480, 95%CI: 0.173–0.810) differed significantly from pseudoprogression (-0.083, 95%CI: −1.138–0.620) group <f:math xmlns:f="http://www.w3.org/1998/Math/MathML" id="M2"> <f:mfenced open="(" close=")" separators="|"> <f:mrow> <f:mi>p</f:mi> <f:mo>=</f:mo> <f:mn>0.015</f:mn> </f:mrow> </f:mfenced> </f:math> . With an rCBV threshold of 0.743, the sensitivity and specificity for discriminating true progression from pseudoprogression were 76.5% and 92.9%, respectively. The Cho/Cr and Cho/NAA ratios of the true progression group (2.520, 95%CI: 2.331–2.773; 2.414 ± 0.665, respectively) were higher than those of the pseudoprogression group (1.719 ± 0.664; 1.499 ± 0.500, respectively) ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M3"> <k:mfenced open="(" close=")" separators="|"> <k:mrow> <k:mi>p</k:mi> <k:mo>=</k:mo> <k:mn>0.001</k:mn> </k:mrow> </k:mfenced> </k:math> , <p:math xmlns:p="http://www.w3.org/1998/Math/MathML" id="M4"> <p:mfenced open="(" close=")" separators="|"> <p:mrow> <p:mi>p</p:mi> <p:mo><</p:mo> <p:mn>0.001</p:mn> </p:mrow> </p:mfenced> </p:math> , respectively). The areas under ROC curve (AUCs) of enhancement pattern, MRS, and DSC-MRI for the differentiation were 0.782, 0.881, and 0.912, respectively. Interestingly, when combined enhancement pattern, MRS, and DSC-MRI variables, the AUC was 0.965 and achieved sensitivity 90.2% and specificity 100.0%. Our results suggest that DSC-MRI can significantly improve the diagnostic performance for identifying glioma progression. DSC-MRI combined with conventional MRI may promptly distinguish true gliomas progression from pseudoprogression when the suspected gadolinium-enhancing lesion was found, without the need for a long-term follow-up.