Morphologic MRI features, diffusion tensor imaging and radiation dosimetric analysis to differentiate...

Area of Science:

• Radiology
• Neuro-oncology
• Medical Imaging

Background:

• Pseudo-progression (PsP) is a treatment effect mimicking tumor progression in gliomas post-chemo-radiation.
• Differentiating PsP from early tumor progression (ETP) is crucial for appropriate patient management.

Purpose of the Study:

• To assess the diagnostic value of MRI morphologic features, diffusion tensor imaging (DTI), and radiation dosimetry in distinguishing PsP from ETP in glioma patients.

Main Methods:

• 163 high-grade glioma patients treated with chemo-radiation were analyzed using serial MRI.
• Modified VASARI scoring system for morphologic features, DTI analysis, and radiation dose-volume histogram analysis of recurrent lesions were employed.
• Comparison of imaging and dosimetric parameters between PsP and ETP groups.

Main Results:

• Larger T2-FLAIR signal abnormality and enhancing component size were associated with ETP, not PsP.
• DTI metrics did not significantly differ between PsP and ETP groups.
• No significant difference in lesion location or correlation with radiation dose distribution was found between the groups.

Conclusions:

• Morphologic MRI features and DTI have limited ability to differentiate PsP from ETP.
• Larger lesion size (T2-FLAIR and enhancing components) suggests ETP.
• Radiation dose distribution does not correlate with MRI changes in differentiating PsP from ETP.