MRI-based contrast clearance analysis shows high differentiation accuracy between radiation-induced reactions and progressive disease after cranial radiotherapy

ESMO Open

article

R. Bodensohn¹  R. Forbrig²  S. Quach³  J. Reis²  A.-L. Boulesteix⁴  U. Mansmann⁴  I. Hadi¹  D.F. Fleischmann¹  J. Mücke¹  A. Holzgreve⁷  N.L. Albert⁷  V. Ruf⁸  M. Dorostkar⁸  S. Corradini¹  J. Herms⁸  C. Belka¹  N. Thon³  M. Niyazi¹ 

[1] Department of Radiation Oncology, University Hospital;Institute of Neuroradiology, University Hospital;Department of Neurosurgery, University Hospital;Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine;German Cancer Consortium;German Cancer Research Center;Department of Nuclear Medicine, University Hospital;Center for Neuropathology and Prion Research, Faculty of Medicine

关键词: pseudoprogression;    radiation necrosis;    stereotactic radiosurgery;    brain metastases;    glioma;   

DOI  :  10.1016/j.esmoop.2022.100424

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Pseudoprogression (PsP) or radiation necrosis (RN) may frequently occur after cranial radiotherapy and show a similar imaging pattern compared with progressive disease (PD). We aimed to evaluate the diagnostic accuracy of magnetic resonance imaging-based contrast clearance analysis (CCA) in this clinical setting.Patients and methods Patients with equivocal imaging findings after cranial radiotherapy were consecutively included into this monocentric prospective study. CCA was carried out by software-based automated subtraction of imaging features in late versus early T1-weighted sequences after contrast agent application. Two experienced neuroradiologists evaluated CCA with respect to PsP/RN and PD being blinded for histological findings. The radiological assessment was compared with the histopathological results, and its accuracy was calculated statistically.Results A total of 33 patients were included; 16 (48.5%) were treated because of a primary brain tumor (BT), and 17 (51.1%) because of a secondary BT. In one patient, CCA was technically infeasible. The accuracy of CCA in predicting the histological result was 0.84 [95% confidence interval (CI) 0.67-0.95; one-sided P = 0.051; n = 32]. Sensitivity and specificity of CCA were 0.93 (95% CI 0.66-1.00) and 0.78 (95% CI 0.52-0.94), respectively. The accuracy in patients with secondary BTs was 0.94 (95% CI 0.71-1.00) and nonsignificantly higher compared with patients with primary BT with an accuracy of 0.73 (95% CI 0.45-0.92), P = 0.16.Conclusions In this study, CCA was a highly accurate, easy, and helpful method for distinguishing PsP or RN from PD after cranial radiotherapy, especially in patients with secondary tumors after radiosurgical treatment.

【 授权许可】

CC BY|CC BY-NC-ND