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Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma
BACKGROUND: There is a need to establish biomarkers that distinguish between pseudoprogression (PsP) and true tumor progression in patients with glioblastoma (GBM) treated with chemoradiation. METHODS: We analyzed magnetic resonance spectroscopic imaging (MRSI) and dynamic susceptibility contrast (D...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9446677/ https://www.ncbi.nlm.nih.gov/pubmed/36071927 http://dx.doi.org/10.1093/noajnl/vdac128 |
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author | El-Abtah, Mohamed E Talati, Pratik Fu, Melanie Chun, Benjamin Clark, Patrick Peters, Anna Ranasinghe, Anthony He, Julian Rapalino, Otto Batchelor, Tracy T Gilberto Gonzalez, R Curry, William T Dietrich, Jorg Gerstner, Elizabeth R Ratai, Eva-Maria |
author_facet | El-Abtah, Mohamed E Talati, Pratik Fu, Melanie Chun, Benjamin Clark, Patrick Peters, Anna Ranasinghe, Anthony He, Julian Rapalino, Otto Batchelor, Tracy T Gilberto Gonzalez, R Curry, William T Dietrich, Jorg Gerstner, Elizabeth R Ratai, Eva-Maria |
author_sort | El-Abtah, Mohamed E |
collection | PubMed |
description | BACKGROUND: There is a need to establish biomarkers that distinguish between pseudoprogression (PsP) and true tumor progression in patients with glioblastoma (GBM) treated with chemoradiation. METHODS: We analyzed magnetic resonance spectroscopic imaging (MRSI) and dynamic susceptibility contrast (DSC) MR perfusion data in patients with GBM with PsP or disease progression after chemoradiation. MRSI metabolites of interest included intratumoral choline (Cho), myo-inositol (mI), glutamate + glutamine (Glx), lactate (Lac), and creatine on the contralateral hemisphere (c-Cr). Student T-tests and area under the ROC curve analyses were used to detect group differences in metabolic ratios and their ability to predict clinical status, respectively. RESULTS: 28 subjects (63 ± 9 years, 19 men) were evaluated. Subjects with true progression (n = 20) had decreased enhancing region mI/c-Cr (P = .011), a marker for more aggressive tumors, compared to those with PsP, which predicted tumor progression (AUC: 0.84 [0.76, 0.92]). Those with true progression had elevated Lac/Glx (P = .0009), a proxy of the Warburg effect, compared to those with PsP which predicted tumor progression (AUC: 0.84 [0.75, 0.92]). Cho/c-Cr did not distinguish between PsP and true tumor progression. Despite rCBV (AUC: 0.70 [0.60, 0.80]) and rCBF (AUC: 0.75 [0.65, 0.84]) being individually predictive of tumor response, they added no additional predictive value when combined with MRSI metabolic markers. CONCLUSIONS: Incorporating enhancing lesion MRSI measures of mI/c-Cr and Lac/Glx into brain tumor imaging protocols can distinguish between PsP and true progression and inform patient management decisions. |
format | Online Article Text |
id | pubmed-9446677 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-94466772022-09-06 Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma El-Abtah, Mohamed E Talati, Pratik Fu, Melanie Chun, Benjamin Clark, Patrick Peters, Anna Ranasinghe, Anthony He, Julian Rapalino, Otto Batchelor, Tracy T Gilberto Gonzalez, R Curry, William T Dietrich, Jorg Gerstner, Elizabeth R Ratai, Eva-Maria Neurooncol Adv Clinical Investigations BACKGROUND: There is a need to establish biomarkers that distinguish between pseudoprogression (PsP) and true tumor progression in patients with glioblastoma (GBM) treated with chemoradiation. METHODS: We analyzed magnetic resonance spectroscopic imaging (MRSI) and dynamic susceptibility contrast (DSC) MR perfusion data in patients with GBM with PsP or disease progression after chemoradiation. MRSI metabolites of interest included intratumoral choline (Cho), myo-inositol (mI), glutamate + glutamine (Glx), lactate (Lac), and creatine on the contralateral hemisphere (c-Cr). Student T-tests and area under the ROC curve analyses were used to detect group differences in metabolic ratios and their ability to predict clinical status, respectively. RESULTS: 28 subjects (63 ± 9 years, 19 men) were evaluated. Subjects with true progression (n = 20) had decreased enhancing region mI/c-Cr (P = .011), a marker for more aggressive tumors, compared to those with PsP, which predicted tumor progression (AUC: 0.84 [0.76, 0.92]). Those with true progression had elevated Lac/Glx (P = .0009), a proxy of the Warburg effect, compared to those with PsP which predicted tumor progression (AUC: 0.84 [0.75, 0.92]). Cho/c-Cr did not distinguish between PsP and true tumor progression. Despite rCBV (AUC: 0.70 [0.60, 0.80]) and rCBF (AUC: 0.75 [0.65, 0.84]) being individually predictive of tumor response, they added no additional predictive value when combined with MRSI metabolic markers. CONCLUSIONS: Incorporating enhancing lesion MRSI measures of mI/c-Cr and Lac/Glx into brain tumor imaging protocols can distinguish between PsP and true progression and inform patient management decisions. Oxford University Press 2022-08-15 /pmc/articles/PMC9446677/ /pubmed/36071927 http://dx.doi.org/10.1093/noajnl/vdac128 Text en © The Author(s) 2022. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Investigations El-Abtah, Mohamed E Talati, Pratik Fu, Melanie Chun, Benjamin Clark, Patrick Peters, Anna Ranasinghe, Anthony He, Julian Rapalino, Otto Batchelor, Tracy T Gilberto Gonzalez, R Curry, William T Dietrich, Jorg Gerstner, Elizabeth R Ratai, Eva-Maria Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title | Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title_full | Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title_fullStr | Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title_full_unstemmed | Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title_short | Magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
title_sort | magnetic resonance spectroscopy outperforms perfusion in distinguishing between pseudoprogression and disease progression in patients with glioblastoma |
topic | Clinical Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9446677/ https://www.ncbi.nlm.nih.gov/pubmed/36071927 http://dx.doi.org/10.1093/noajnl/vdac128 |
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