Differentiation of Postoperative Tumor Recurrence and Pseudoprogression in Gliomas: A Comparative Study of Six Diffusion Models

Abstract

Rationale and objectives: The purpose of this study is to investigate whether six diffusion models derived from multi-b-value diffusion-weighted imaging can enhance the differentiation between pseudoprogression (PsP) and postoperative tumor recurrence (TR) in glioma patients, with the aim of providing clinical insights.

Materials and methods: A retrospective study was conducted on 82 patients with WHO grade 2-4 gliomas who underwent surgery at our hospital, with MRI sequences including T₁WI, T₂WI, T₂FLAIR, contrast-enhanced T₁WI, and multi-b-value DWI. Postoperative follow-up or secondary surgery pathology confirmed 46 cases of TR and 36 cases of PsP. Six diffusion models were fitted based on multi-b-value DWI sequences, including monoexponential DWI (Mono_DWI), intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), stretched-exponential model (SEM), fractional-order calculus (FROC), and continuous-time random-walk (CTRW) model. ROIs were manually outlined to calculate the average values of each parameter. Differences between the two groups were compared using T-tests or Mann-Whitney U tests. The diagnostic performance of individual parameters was analyzed using ROC curve analysis, and the diagnostic performance of each model was compared using multivariate logistic regression.

Results: Among the 14 parameter maps, significant differences were found in all models (P<0.0036) except for IVIM_D*, IVIM_f. ROC curve analysis showed that CTRW_D demonstrated the highest AUC of 0.8484 (0.7549-0.9240). Further analysis of the diffusion models showed that CTRW performed the best among all models, with an AUC of 0.8635 (0.7816-0.9454), slightly higher than the FROC model, which had an AUC of 0.8629 (0.7839-0.9420).

Conclusion: The various diffusion models derived from multi-b-value DWI sequences can effectively distinguish between postoperative recurrence and pseudoprogression in gliomas. Among these models, the CTRW and FROC models are the two optimal models, demonstrating comparable diagnostic performance.

Keywords: Diffusion MRI; Glioma; Postoperative tumor recurrence; Pseudoprogression.