Longitudinal, leakage corrected and uncorrected rCBV during the first-line treatment of glioblastoma: a prospective...

Dynamic susceptibility contrast (DSC) MR-perfusion is becoming a standard of care for the monitoring of glioblastoma. Yet, technical standards are lacking and measurements without leakage correction are still common. Also, data on leakage corrected measurements during stable disease is scarce. In this study we hypothesized that basic leakage correction would significantly enhance data quality during stable disease and improve progress detection. We furthermore investigated whether longitudinal data could increase diagnostic performance.

Patients with histologically proven glioblastoma undergoing first-line therapy were prospectively recruited. We conducted DSC perfusion measurements without prebolus administration in 6-week intervals from the end of radiotherapy until progression. Maximum relative cerebral volume values (rCBV_max) with and without leakage correction were calculated using Philips IntelliSpace®.

We recruited 16 patients and conducted 82 MRI scans with a mean follow up of 7.2 month. During stable disease, corrected rCBV_max was significantly more stable than uncorrected rCBV_max. Detection of progression with a rCBV_max cutoff was better for corrected (specificity 86%) than for uncorrected rCBV_max (specificity 41%). Interestingly, the increase of corrected rCBV_max upon progression also had a good diagnostic performance with a combination of both cutoffs delivering the best result (sensitivity/specificity 89%/93%).

Corrected rCBV_max supports the imaging finding of a stable disease and large increases during longitudinal observation support the diagnosis of tumor progression. rCBV values without prebolus or leakage correction are not reliable to monitor glioblastomas. Further studies to investigate the value of longitudinal rCBV dynamics for the differentiation of real tumor progression from pseudoprogression are warranted.