Gliomas Progression And Recurrence: A Preliminary Study Of MRI Differentiation And Survival Assessment

Part 1 Dynamic susceptibility contrast perfusion helps improve the evalution of gliomas progressionObjective: Accurate differentiation true progression from pseudoprogression in gliomas after treatment is still a challenge and may help in selecting patients for salvage therapy.To assess the impaction of dynamic susceptibility contrast perfusion MRI(DSC-MRI)in patients with gliomasafter standard treatment according to NCCN guideline for differentiating true progression from pseudoprogression.Methods:This retrospective study enrolled 53 patients with suspicious gadolinium-enhancing lesion.These patients were diagnosed as WHO grade II(n=4),III(n=26),and IV(n=23)gliomas.Longitudinal MRI follow-up(>12 months)or reoperation(n=3)were assessed to confirm true progression(n=44)versus pseudoprogression(n=9).We compared the characteristics of true progression and pseudoprogression groups,and assessed the diagnostic performance of various MRI factors.t test or Mann-Whitney U test,receiver operating characteristic curve(ROC),as well as intraclass correlation coefficient(ICC)were used for statistical analysis.Results: The relative cerebral blood volume(r CBV)and Cho/Cr ratio in true progression group(1.16,95% CI: 1.20-1.76;2.42,95%CI: 2.31-2.79,separately)were significantly higher than those in pseudoprogression group(0.48,95%CI: 0.42-0.69;1.77,95%CI: 1.21-2.06,separately)(P<0.001,P=0.002).With the r CBV threshold of 0.743,the sensitivity and specificity for discriminating true progression from pseudoprogression were 79.1% and 88.9% separately.In those patients(n=46)who had DWI data,ADC value of true progression group(523.00,95%CI: 533.06-750.92)was lower than that of pseudoprogression counterpart(903.14±491.65),but without singificant difference(P=0.134).The areas under ROC curve(AUCs)of enhancement pattern,MRS,DSC-MRI for differentiation were 0.783,0.886,0.904 separately.Interestingly,when combined enhancement pattern,MRS,DSC-MRI variables,the AUC achieved 0.965,and sensitivity 90.9%,specificity 100%.Conclusion:The rCBV is a valuable imaging marker for distinguishing true progression from pseudoprogression in glioma patients.DSC MRI may improve the diagnostic performance when added to other MRI variables.Part 2 Preliminary study of MRI recurrence pattern of high-grade glioma and its effect on survivalObjective: Studies of intracranial high-grade glioma(HGG)recurrence MRI are mainly early diagnosis and functional imaging.The purpose of this study was to analyze the MRI recurrence pattern and explore its impact on prognosis.Methods:A retrospective analysis of 63 cases of HGG confirmed by pathology and standard treatment(29 cases of grade III,34 cases of grade IV),and follow-up of longitudinal MRI for at least 12 months or surgical pathology(4 cases)confirmed recurrence.The differences in MRI signs between the local recurrence group and the non-local recurrence group were compared,and their impact on survival was evaluated.Local recurrence is defined as the recurrence of the lesion in the residual cavity or within 20 mm from the residual cavity.Results: The median follow-up time was 450 days.There were 41 cases(65.1%)of local recurrence and 22 cases(34.9%)of non-local recurrence group.All patients had a median progression-free survival(PFS)of 300 days and a median overall survival(OS)of 600 days.The median PFS was 210 days in patients with local recurrence,330 days in patients without local recurrence(P=0.769),and the median OS was 540 days and 390 days,respectively(P<0.001).Early(within 2 years after the initial operation)and non-early(within 2 years after the initial operation)recurrence,rapid(?6 months),and slow(>6 months)imaging progression were significantly related to the recurrence pattern(P=0.018,P=0.017).The Cox proportional hazard model concluded that the recurrence pattern(HR: 2.604),the sooner or later recurrence(HR: 0.004),the rapid progress of imaging(HR: 0.330),and the grade of glioma(HR: 2.998)are factors that affect OS.the recurrence pattern(HR: 0.122)and relapse sooner or later(HR: 0.022)are factors that affect PFS.Conclusion:HGG recurrence is more common locally;and patients with local recurrence have longer OS but shorter PFS.local recurrence is associated with early recurrence and rapid progression of imaging.Early relapse and fast imaging progress have a significant negative impact on OS.