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

1 Citation (Scopus)

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 1 2018
Externally publishedYes

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Glioma
Magnetic Resonance Imaging
Therapeutics
Gadolinium
Radiation
Drug Therapy

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Apparent transverse relaxation (R2∗) on MRI as a method to differentiate treatment effect (pseudoprogression) versus progressive disease in chemoradiation for malignant glioma. / Belliveau, Jean-Guy; Bauman, Glenn S.; Macdonald, David; Macdonald, Maria; Klassen, L. Martyn; Menon, Ravi S.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 62, No. 2, 01.04.2018, p. 224-231.

Research output: Contribution to journalArticle

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