Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma

R. J. Young, A. Gupta, A. D. Shah, J. J. Graber, Z. Zhang, W. Shi, A. I. Holodny, A. M P Omuro

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Objective: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). Methods: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ or Fisher exact test. Results: Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). Conclusions: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.

Original languageEnglish (US)
Pages (from-to)1918-1924
Number of pages7
JournalNeurology
Volume76
Issue number22
DOIs
StatePublished - May 31 2011
Externally publishedYes

Fingerprint

Glioblastoma
Pathology
Radiotherapy
Retrospective Studies
Magnetic Resonance Imaging
Physicians
Drug Therapy
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Young, R. J., Gupta, A., Shah, A. D., Graber, J. J., Zhang, Z., Shi, W., ... Omuro, A. M. P. (2011). Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. Neurology, 76(22), 1918-1924. https://doi.org/10.1212/WNL.0b013e31821d74e7

Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. / Young, R. J.; Gupta, A.; Shah, A. D.; Graber, J. J.; Zhang, Z.; Shi, W.; Holodny, A. I.; Omuro, A. M P.

In: Neurology, Vol. 76, No. 22, 31.05.2011, p. 1918-1924.

Research output: Contribution to journalArticle

Young, RJ, Gupta, A, Shah, AD, Graber, JJ, Zhang, Z, Shi, W, Holodny, AI & Omuro, AMP 2011, 'Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma', Neurology, vol. 76, no. 22, pp. 1918-1924. https://doi.org/10.1212/WNL.0b013e31821d74e7
Young, R. J. ; Gupta, A. ; Shah, A. D. ; Graber, J. J. ; Zhang, Z. ; Shi, W. ; Holodny, A. I. ; Omuro, A. M P. / Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. In: Neurology. 2011 ; Vol. 76, No. 22. pp. 1918-1924.
@article{554a2e8ec37a4ca995153bd8ae85e6c6,
title = "Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma",
abstract = "Objective: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). Methods: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ or Fisher exact test. Results: Sixty-three (67.7{\%}) of the 93 patients had EP, of which 22 (34.9{\%}) were diagnosed by pathology. Thirty patients (32.3{\%}) had PsP; 6 (16.7{\%} of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1{\%} sensitivity, 93.3{\%} specificity, and 41.8{\%} negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). Conclusions: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.",
author = "Young, {R. J.} and A. Gupta and Shah, {A. D.} and Graber, {J. J.} and Z. Zhang and W. Shi and Holodny, {A. I.} and Omuro, {A. M P}",
year = "2011",
month = "5",
day = "31",
doi = "10.1212/WNL.0b013e31821d74e7",
language = "English (US)",
volume = "76",
pages = "1918--1924",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma

AU - Young, R. J.

AU - Gupta, A.

AU - Shah, A. D.

AU - Graber, J. J.

AU - Zhang, Z.

AU - Shi, W.

AU - Holodny, A. I.

AU - Omuro, A. M P

PY - 2011/5/31

Y1 - 2011/5/31

N2 - Objective: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). Methods: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ or Fisher exact test. Results: Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). Conclusions: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.

AB - Objective: To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). Methods: This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ or Fisher exact test. Results: Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). Conclusions: Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.

UR - http://www.scopus.com/inward/record.url?scp=79958108803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958108803&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e31821d74e7

DO - 10.1212/WNL.0b013e31821d74e7

M3 - Article

C2 - 21624991

AN - SCOPUS:79958108803

VL - 76

SP - 1918

EP - 1924

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 22

ER -