Apparent transverse relaxation (R2∗) on MRI as a method to differentiate treatment effect (pseudoprogression) versus progressive disease in chemoradiation for malignant glioma

Jean Guy Belliveau, Glenn S. Bauman, David Macdonald, Maria Macdonald, L. Martyn Klassen, Ravi S. Menon

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Introduction: Pseudoprogression (psPD) is a transient post-treatment imaging change that is commonly seen when treating glioma with chemotherapy and radiation. The use of apparent transverse relaxation rate (R2*), which is calculated from a contrast-free multi-echo gradient echo Magnetic Resonance Imaging (MRI) sequence, may allow for quantitative identification of patients with suspected psPD. Methods: We acquired a multi-echo gradient echo sequence using a 3T-Siemens Prisma MRI. The signal decay through the echoes was fitted to provide the (R2*) coefficient. We segmented the T1-gadolinium enhancing the image to provide a contrast enhancing lesion (CEL) and the FLAIR hyperintensity to provide a non-enhancing lesion (NEL). These regions of interest were applied to the multi-echo gradient echo to acquire a mean (R2*) within the CEL and NEL. We additionally acquired ADC data to attempt to corroborate our findings. Results: We found that patients who later exhibited PD exhibited a higher (R2*) within the CEL as well as a higher ratio of CEL to NEL. Our data correctly distinguished pseudoprogression from treatment effect in 9/9 patients, while ADC corrected identified 7/9 patients using an absolute ADC of 1200 × 10−6mm2/s. Conclusions: Our method seems promising for the accurate identification of psPD, and the technique is amenable to evaluation in larger, multi-centre patient cohorts.

Original languageEnglish (US)
Pages (from-to)224-231
Number of pages8
JournalJournal of Medical Imaging and Radiation Oncology
Volume62
Issue number2
DOIs
StatePublished - Apr 2018

Keywords

  • R 2 ∗
  • concurrent chemoradiotherapy
  • glioma
  • progression
  • pseudoprogression

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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