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Differentiating Glioma Recurrence and Pseudoprogression by APTw CEST MRI.

Kianush Karimian-Jazi1, Noah Enbergs, Evgeny Golubtsov

  • 1From the Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (K.K.-J., N.E., E.G., K.S., J.U., H.F.-P., D.S., V.S., J.M.K., I.P., S.H., M.B., M.O.B.); Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany (K.K.-J., F.W., W.W.); Department of Neurology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany (D.B., F.M.I., F.W., W.W.); DKTK, DKFZ, Clinical Cooperation Unit Neuropathology, Heidelberg, Germany (F.M.I.); Division of Radiology, DKFZ, Heidelberg, Germany (N.V., D.P.); Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, DKTK, DKFZ, Heidelberg, Germany (L.B., M.P., M.O.B.); Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany (L.B., M.P.); Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.P.); and Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (D.P.).

Investigative Radiology
|December 7, 2024
PubMed
Summary

Amide proton transfer-weighted (APTw) MRI effectively distinguishes recurrent glioma progression from pseudoprogression. This advanced imaging reveals previously undetected molecular heterogeneity and invasion patterns, aiding in glioma monitoring.

Keywords:
CESTamide proton transfer–weighted imagingheterogeneityimaging biomarkerrecurrencerecurrent malignant glioma

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Area of Science:

  • Neuro-oncology
  • Medical Imaging
  • Biomarkers

Background:

  • Recurrent glioma presents significant treatment resistance due to heterogeneity and invasiveness.
  • Conventional MRI has limitations in assessing these key glioma characteristics.
  • Amide proton transfer-weighted (APTw) MRI is explored as a novel imaging biomarker.

Purpose of the Study:

  • To investigate APTw MRI at 3 Tesla for elucidating molecular heterogeneity and invasion patterns in recurrent glioma.
  • To compare APTw MRI findings in recurrent glioma versus pseudoprogression (PsPD).

Main Methods:

  • Prospective monocenter trial including 30 patients with recurrent glioma and 12 with PsPD.
  • APTw MRI at 3 T was performed alongside standard anatomical MRI sequences.
  • Quantification of APTw signals in regions of interest including FLAIR lesions, contrast-enhancing lesions, and resection cavities.

Main Results:

  • APTw values were significantly higher in enhancing tumor parts and progressive disease compared to non-enhancing lesions and PsPD.
  • APTw imaging identified heterogeneity within FLAIR lesions not detectable by conventional MRI.
  • Increased APTw signals in the resection cavity at recurrence were observed, differentiating it from PsPD.

Conclusions:

  • APTw MRI can differentiate between progressive disease and pseudoprogression in glioma.
  • This technique reveals previously undetectable imaging patterns during glioma recurrence, including resection cavity alterations.
  • APTw imaging shows clinical potential as an imaging biomarker for glioma monitoring in neuro-oncology.