Validation of multiparametric MRI based prediction model in identification of pseudoprogression in glioblastomas.

de Godoy, Laiz Laura, Mohan, Suyash, Wang, Sumei, Nasrallah, MacLean P, Sakai, Yu, O'Rourke, Donald M, Bagley, Stephen, Desai, Arati, Loevner, Laurie A, Poptani, Harish ORCID: 0000-0002-0593-3235
et al (show 1 more authors) (2023) Validation of multiparametric MRI based prediction model in identification of pseudoprogression in glioblastomas. Journal of translational medicine, 21 (1). p. 287.

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<h4>Background</h4>Accurate differentiation of pseudoprogression (PsP) from tumor progression (TP) in glioblastomas (GBMs) is essential for appropriate clinical management and prognostication of these patients. In the present study, we sought to validate the findings of our previously developed multiparametric MRI model in a new cohort of GBM patients treated with standard therapy in identifying PsP cases.<h4>Methods</h4>Fifty-six GBM patients demonstrating enhancing lesions within 6 months after completion of concurrent chemo-radiotherapy (CCRT) underwent anatomical imaging, diffusion and perfusion MRI on a 3 T magnet. Subsequently, patients were classified as TP + mixed tumor (n = 37) and PsP (n = 19). When tumor specimens were available from repeat surgery, histopathologic findings were used to identify TP + mixed tumor (> 25% malignant features; n = 34) or PsP (< 25% malignant features; n = 16). In case of non-availability of tumor specimens, ≥ 2 consecutive conventional MRIs using mRANO criteria were used to determine TP + mixed tumor (n = 3) or PsP (n = 3). The multiparametric MRI-based prediction model consisted of predictive probabilities (PP) of tumor progression computed from diffusion and perfusion MRI derived parameters from contrast enhancing regions. In the next step, PP values were used to characterize each lesion as PsP or TP+ mixed tumor. The lesions were considered as PsP if the PP value was < 50% and TP+ mixed tumor if the PP value was ≥ 50%. Pearson test was used to determine the concordance correlation coefficient between PP values and histopathology/mRANO criteria. The area under ROC curve (AUC) was used as a quantitative measure for assessing the discriminatory accuracy of the prediction model in identifying PsP and TP+ mixed tumor.<h4>Results</h4>Multiparametric MRI model correctly predicted PsP in 95% (18/19) and TP+ mixed tumor in 57% of cases (21/37) with an overall concordance rate of 70% (39/56) with final diagnosis as determined by histopathology/mRANO criteria. There was a significant concordant correlation coefficient between PP values and histopathology/mRANO criteria (r = 0.56; p < 0.001). The ROC analyses revealed an accuracy of 75.7% in distinguishing PsP from TP+ mixed tumor. Leave-one-out cross-validation test revealed that 73.2% of cases were correctly classified as PsP and TP + mixed tumor.<h4>Conclusions</h4>Our multiparametric MRI based prediction model may be helpful in identifying PsP in GBM patients.

Item Type: Article
Uncontrolled Keywords: Glioblastoma, Treatment response, Multiparametric MRI, Pseudoprogression, Diffusion MR imaging, Perfusion MR imaging
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 04 May 2023 08:29
Last Modified: 13 Jun 2023 01:22
DOI: 10.1186/s12967-023-03941-x
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