Differentiation of tumor progression from pseudoprogression in glioblastoma patients with GRASP DCE-MRI and DSC-MRI

This study investigates the diagnostic accuracy of combined Golden Angle Radial Sparse Parallel Dynamic contrast-enhanced (GRASP DCE-) and Dynamic susceptibility contrast (DSC) MRI in differentiating PD from PsP following RCT in differentiating progressive disease (PD) from pseudoprogression (PsP) following radiochemotherapy (RCT) in glioblastoma patients.

This retrospective study included glioblastoma patients who underwent surgery and RCT between 2017 and 2021 and developed contrast-enhancing lesions suspicious for PD or PsP and had GRASP DCE- and DSC-MRI. Diagnostic accuracy of perfusion parameters was evaluated using the area under the receiver operating characteristics curve (AUC) at both initial suspicion of progression and confirmation MRI.

Among 83 patients, 62 were classified as PD and 21 as PsP on serial MRI for all patients, with additional histological confirmation in 18 patients. Median perfusion parameters values were higher in the PD group in comparison to the PsP group (rCBV: 3.48 vs. 1.60, p < .001; Vp: 0.08 vs. 0.05, p = .032). At initial suspicion of progression, the combination of Ktrans, Ve, Vp and rCBV improved diagnostic accuracy in differentiating PD from PsP (AUC = 0.77, 95 % CI [0.62-0.93]) compared to rCBV alone (AUC = 0.69, 95 % CI [0.54-0.85]). At confirmation MRI (>12 weeks post-RCT), the added value of DCE was more modest (AUC improvement from 0.88 to 0.90). Suggested optimal thresholds at confirmation were: rCBV 2.87 (Sensitivity 71 %, Specificity 94 %), Ktrans 0.12 min^-1 (73 %, 76 %), Ve 0.31 (75 %, 65 %), and Vp 0.05 (78 %, 59 %).

Combining DCE- with DSC-MRI may enhance diagnostic accuracy in distinguishing progressive disease from pseudoprogression in glioblastoma, particularly during the early post-radiochemotherapy phase when treatment decisions are critical. As the added value of DCE-MRI is limited beyond 12 weeks post-radiochemotherapy, the full protocol is best reserved for early suspicion of progression or unclear cases, while DSC-MRI alone may be sufficient for confirmation imaging after this period.