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. 2011 May 31;76(22):1918-24.
doi: 10.1212/WNL.0b013e31821d74e7.

Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma

R J Young  1 , A Gupta, A D Shah, J J Graber, Z Zhang, W Shi, A I Holodny, A M P Omuro
Affiliations

Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma

R J Young et al. Neurology. .

Abstract

Objective: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP).

Methods: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ(2) or Fisher exact test.

Results: Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0).

Conclusions: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.

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Figures

Figure 1
Figure 1. STARD diagram
RT = radiation therapy.
Figure 2
Figure 2. Subependymal enhancement in a patient with early progression
Contrast T1-weighted images. Pre–radiation therapy (RT) and 1 day after resection (A), the patient shows a left pterional craniotomy with a blood/fluid-filled surgical cavity in the temporal lobe and minute enhancement in the mesial temporal lobe. One month post-RT (B), there is increased enhancement in the mesial temporal lobe and new enhancement along the subependymal margin of the temporal horn. Five months post-RT (C), the subependymal enhancement has extended posteriorly to the occipital horn, and there are 2 new sites of enhancement in the lateral temporal lobe. The patient continued to show clinical deterioration, and treatment was switched from adjuvant temozolomide to bevacizumab for tumor progression.
Figure 3
Figure 3. Kaplan-Meier survival curves
(A) Overall survival of the pseudoprogression (PsP) group was longer than of the early progression (EP) group. (B) Overall survival of the EP group was shorter than the PsP, stable, and improved groups. The latter 3 groups had similar overall survival.
See this image and copyright information in PMC

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