Pseudoprogression of Glioblastoma after Chemo- and Radiation Therapy: Diagnosis by Using Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging with Ferumoxytol versus Gadoteridol and Correlation with Survival

被引:112
作者
Gahramanov, Seymur [1 ]
Muldoon, Leslie L. [1 ]
Varallyay, Csanad G. [1 ]
Li, Xin
Kraemer, Dale F. [8 ]
Fu, Rongwei [3 ,4 ]
Hamilton, Bronwyn E. [5 ]
Rooney, William D. [6 ]
Neuwelt, Edward A. [1 ,2 ,7 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Neurol, Portland, OR 97239 USA
[2] Oregon Hlth & Sci Univ, Dept Neurosurg, Portland, OR 97239 USA
[3] Oregon Hlth & Sci Univ, Dept Publ Hlth & Prevent Med, Portland, OR 97239 USA
[4] Oregon Hlth & Sci Univ, Dept Emergency Med, Portland, OR 97239 USA
[5] Oregon Hlth & Sci Univ, Dept Radiol, Portland, OR 97239 USA
[6] Oregon Hlth & Sci Univ, Adv Imaging Res Ctr, Portland, OR 97239 USA
[7] Dept Vet Affairs Med Ctr, Off Res & Dev, Portland, OR USA
[8] Oregon State Univ, Dept Med Informat & Clin Epidemiol, Portland, OR USA
关键词
CEREBRAL BLOOD-VOLUME; CENTRAL-NERVOUS-SYSTEM; HIGH-GRADE GLIOMAS; CONCOMITANT RADIOCHEMOTHERAPY; MALIGNANT GLIOMA; TUMOR GRADE; PROGRESSION; BRAIN; TEMOZOLOMIDE; PREDICT;
D O I
10.1148/radiol.12111472
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To compare gadoteridol and ferumoxytol for measurement of relative cerebral blood volume (rCBV) in patients with glioblastoma multiforme (GBM) who showed progressive disease at conventional magnetic resonance (MR) imaging after chemo-and radiation therapy (hereafter, chemoradiotherapy) and to correlate rCBV with survival. Materials and Methods: Informed consent was obtained from all participants before enrollment in one of four institutional review board-approved protocols. Contrast agent leakage maps and rCBV were derived from perfusion MR imaging with gadoteridol and ferumoxytol in 19 patients with apparently progressive GBM on conventional MR images after chemoradiotherapy. Patients were classified as having high rCBV (. 1.75), indicating tumor, and low rCBV (. 1.75), indicating pseudo-progression, for each contrast agent separately, and with or without contrast agent leakage correction for imaging with gadoteridol. Statistical analysis was performed by using Kaplan-Meier survival plots with the log-rank test and Cox proportional hazards models. Results: With ferumoxytol, rCBV was low in nine (47%) patients, with median overall survival (mOS) of 591 days, and high rCBV in 10 (53%) patients, with mOS of 163 days. A hazard ratio of 0.098 (P =.004) indicated significantly improved survival. With gadoteridol, rCBV was low in 14 (74%) patients, with mOS of 474 days, and high in five (26%), with mOS of 156 days and a nonsignificant hazard ratio of 0.339 (P =.093). Five patients with mismatched high rCBV with ferumoxytol and low rCBV with gadoteridol had an mOS of 171 days. When leakage correction was applied, rCBV with gadoteridol was significantly associated with survival (hazard ratio, 0.12; P =.003). Conclusion: Ferumoxytol as a blood pool agent facilitates differentiation between tumor progression and pseudoprogression, appears to be a good prognostic biomarker, and unlike gadoteridol, does not require contrast agent leakage correction. (C) RSNA, 2012
引用
收藏
页码:842 / 852
页数:11
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