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Post-Chemo-Radiotherapy Response and Pseudo-Progression Evaluation on Glioma Cell Types by Multi-Parametric Magnetic Resonance Imaging: A Prospective Study Publisher



Zamanian M1 ; Abedi I1 ; Danazadeh F2 ; Amouheidari A3 ; Shahreza BO4
Authors
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Authors Affiliations
  1. 1. Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Radiology, School of Paramedicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Department of Oncology, Isfahan Milad Hospital, Isfahan, Iran
  4. 4. Department of Radiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran

Source: BMC Medical Imaging Published:2023


Abstract

Background: We focused on Differentiated pseudoprogression (PPN) of progression (PN) and the response to radiotherapy (RT) or chemoradiotherapy (CRT) using diffusion and metabolic imaging. Methods: Seventy-five patients with glioma were included in this prospective study (approved by the Iranian Registry of Clinical Trials (IRCT) (IRCT20230904059352N1) in September 2023). Contrast-enhanced lesion volume (CELV), non-enhanced lesion volume (NELV), necrotic tumor volume (NTV), and quantitative values ​​of apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (Cho/Cr, Cho/NAA and NAA/Cr) were calculated by a neuroradiologist using a semi-automatic method. All patients were followed at one and six months after CRT. Results: The results of the study showed statistically significant changes before and six months after RT-CRT for M-CELV in all glioma types (p < 0.05). In glioma cell types, the changes in M-ADC, M-Cho/Cr, and Cho/NAA indices for PN were incremental and greater for PPN patients. M-NAA/Cr ratio decreased after six months which was significant only on PN for GBM, and Epn (p < 0.05). A significant difference was observed between diffusion indices, metabolic ratios, and CELV changes after six months in all types (p < 0.05). None of the patients were suspected PPN one month after treatment. The DWI/ADC indices had higher sensitivity and specificity (98.25% and 96.57%, respectively). Conclusion: The results of the present study showed that ADC values and Cho/Cr and Cho/NAA ratios can be used to differentiate between patients with PPN and PN, although ADC is more sensitive and specific. © 2023, The Author(s).
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