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Live-Cell Imaging Assays to Study Glioblastoma Brain Tumor Stem Cell Migration and Invasion
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Pseudoprogression of brain tumors.

Stefanie C Thust1,2,3, Martin J van den Bent4, Marion Smits5

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Journal of Magnetic Resonance Imaging : JMRI
|May 8, 2018
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Summary

Pseudoprogression in brain tumors is a common challenge after treatment. Advanced magnetic resonance imaging (MRI) techniques, like perfusion MRI and MR spectroscopy, are crucial for accurate diagnosis, distinguishing it from true tumor growth.

Keywords:
MRIbrain neoplasmsdiffusiongliomamagnetic resonance imagingperfusion weightedproton magnetic resonance spectroscopy

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Area of Science:

  • Neuro-oncology
  • Radiology
  • Medical Imaging

Background:

  • Pseudoprogression is a significant clinical issue following brain tumor treatment, particularly high-grade gliomas.
  • It complicates patient management and clinical trial interpretation due to its radiological appearance mimicking true tumor progression.
  • Variable clinical definitions contribute to a wide reported incidence range of 9-30%.

Purpose of the Study:

  • To review the definition, incidence, clinical impact, and MRI findings associated with brain tumor pseudoprogression.
  • To highlight the limitations of conventional MRI and the necessity of advanced imaging techniques for diagnosis.
  • To assess the diagnostic performance of various advanced MRI methods in differentiating pseudoprogression from true tumor growth.

Main Methods:

  • Review of literature on pseudoprogression in brain tumors, focusing on high-grade gliomas.
  • Analysis of diagnostic capabilities of conventional structural MRI, perfusion MRI, MR spectroscopy (MRS), and diffusion-weighted imaging (DWI).
  • Evaluation of reported diagnostic accuracy rates for different imaging modalities and their combinations.

Main Results:

  • Conventional MRI is insufficient for distinguishing pseudoprogression from true progression.
  • Perfusion MRI demonstrates high diagnostic accuracy for pseudoprogression.
  • Combinations of MRS with DWI and/or perfusion MRI achieve diagnostic accuracy up to or exceeding 90%.

Conclusions:

  • Advanced MRI techniques, especially combinations like MRS with perfusion MRI/DWI, are essential for accurate pseudoprogression diagnosis.
  • While diagnostic accuracy is high, it is not 100%, and current studies are often limited by small sample sizes and retrospective designs.
  • Future research focusing on harmonized acquisition, quantitative MRI, and computer-aided diagnostics holds promise for improved accuracy.