Prediction of Pseudoprogression in Patients with Glioblastomas Using the Initial and Final Area Under the Curves Ratio Derived from Dynamic Contrast-Enhanced T1-Weighted Perfusion MR Imaging

BACKGROUND AND PURPOSE: Dynamic contrast-enhanced T1-weighted perfusion MR imaging is much less susceptible to artifacts, and its high spatial resolution allows accurate characterization of the vascular microenvironment of the lesion. The purpose of this study was to test the predictive value of the initial and final area under the time signal-intensity curves ratio derived from dynamic contrast-enhanced perfusion MR imaging to differentiate pseudoprogression from early tumor progression in patients with glioblastomas. MATERIALS AND METHODS: Seventy-nine consecutive patients who showed new or enlarged, contrast-enhancing lesions within the radiation field after concurrent chemoradiotherapy were assessed by use of conventional and dynamic contrast-enhanced perfusion MR imaging. The bimodal histogram parameters of the area under the time signal-intensity curves ratio, which included the mean area under the time signal-intensity curves ratio at a higher curve (mAUCR(H)), 3 cumulative histogram parameters (AUCR(50), AUCR(75), and AUCR(90)), and the area under the time signal-intensity curves ratio at mode (AUCR(mode)), were calculated and correlated with the final pathologic or clinical diagnosis. The best predictor for differentiation of pseudoprogression from early tumor progression was determined by receiver operating characteristic curve analyses. RESULTS: Seventy-nine study patients were subsequently classified as having pseudoprogression (n = 37, 46.8%) or early tumor progression (n = 42, 53.2%). There were statistically significant differences of mAUCR(H), AUCR(50), AUCR(75), AUCR(90), and AUCR(mode) between the 2 groups (P < .0001, each). Receiver operating characteristic curve analyses showed the mAUCR(H) to be the best single predictor of pseudoprogression, with a sensitivity of 90.1% and a specificity of 82.9%. AUCR(50) was found to be the most specific predictor of pseudoprogression, with a sensitivity of 87.2% and a specificity of 83.1%. CONCLUSIONS: A bimodal histogram analysis of the area under the time signal-intensity curves ratio derived from dynamic contrast-enhanced perfusion MR imaging can be a potential, noninvasive imaging biomarker for monitoring early treatment response in patients with glioblastomas.