Article Figures & Data
Figures
- Fig 1.
Flowchart of the inclusion and exclusion criteria of our study population.
- Fig 2.
A 68-year-old female patient with surgically proved glioblastoma presented A, a newly appeared enhancing nodule on DCE-MR imaging taken 1 month after temozolomide chemoradiation. The lesion was not identified on the postoperative MR imaging. B, The lesion was markedly increased after 6 cycles of temozolomide chemotherapy, implying that the lesion was true progression according to the Response Assessment in Neuro-Oncology criteria. The pharmacokinetic DCE maps, especially those for Ktrans and Kep, showed a bright signal from both the C, fixed T1 and D, measured T1 methods.
- Fig 3.
A 57-year-old female patient with surgically proved glioblastoma presented A, a newly appeared enhancing nodule on DCE-MR imaging taken 1 month after temozolomide chemoradiation. B, The lesion had disappeared after 6 cycles of temozolomide chemotherapy, defining the lesion as a pseudoprogression according to the Response Assessment in Neuro-Oncology criteria. The pharmacokinetic DCE maps, especially those for Ktrans and Kep, showed less intense signals from both C, the fixed T1 and D, measured T1 methods.
Tables
Variable True Progression (n = 15) Pseudoprogression (n = 22) P Valuea Age, yr (mean ± SD) 59.6 ± 11.9 56.7 ± 13.7 .61 Gender .12 Male 9 (60.0%) 17 (77.3%) Female 6 (40.0%) 5 (22.7%) Surgery .24 Biopsy 4 (26.7%) 2 (9.1%) Subtotal 6 (40.0%) 9 (40.9%) Total 5 (33.3%) 11 (50.0%) Time interval of end of TMZ-chemoradiation to DCE MRI, d (mean ± SD [range]) 27.0 ± 7.3 [15–44] 28.7 ± 6.0 [17–44] .39 End of adjuvant TMZ chemotherapy to follow-up MRI, d (mean ± SD [range]) 31.2 ± 10.6 [20–53]b 26.2 ± 8.7 [16–54] .46 Initial operation to the last follow-up, d (mean ± SD [range]) 391.4 ± 156.3 [224–716] 657.3374.7 [274–1774] .002 - Table 2:
Comparison of the DCE pharmacokinetic parameters of patients with true progression versus pseudoprogression
Pharmacokinetic Parameter T1 Method True Progression (n = 15) Pseudoprogression (n = 22) P Valuea Intraclass Correlation Coefficient [95% CI] Mean ± SD Median [range] Mean ± SD Median [range] Intraobserver Interobserver Ktrans, min−1 Fixed 0.138 ± 0.148 0.096 [0.042–0.579] 0.068 ± 0.043 0.064 [0.0005–0.154] .05b 0.893 [0.792–0.945] 0.897 [0.799–0.947] Measured 0.126 ± 0.139 0.069 [0.025–0.499] 0.056 ± 0.045 0.058 [0.0001–0.194] .10 0.923 [0.850–0.960] 0.943 [0.888–0.970] Kep, min−1 Fixed 0.321 ± 0.244 0.244 [0.135–1.082] 0.179 ± 0.103 0.179 [0.024–0.483] .01b 0.910 [0.825–0.954] 0.929 [0.862–0.963] Measured 0.224 ± 0.108 0.202 [0.035–0.396] 0.192 ± 0.148 0.157 [0.009–0.494] .47 0.861 [0.729–0.928] 0.882 [0.771–0.939] Vp, % Fixed 3.309 ± 4.429 1.468 [0.709–18.298] 1.998 ± 1.462 1.705 [0.140–6.723] .60 0.872 [0.752–0.934] 0.888 [0.784–0.943] Measured 2.358 ± 2.701 1.339 [0.478–10.407] 1.521 ± 1.456 1.134 [0.081–6.056] .27 0.800 [0.605–0.895] 0.688 [0.394–0.839] Ve Fixed 0.536 ± 0.330 0.446 [0.168–1.050] 0.506 ± 0.284 0.482 [0.114–1.156] .77 0.761 [0.537–0.877] 0.718 [0.516–0.844] Measured 0.550 ± 0.511 0.377 [0.121–1.192] 0.316 ± 0.265 0.270 [0.041–1.297] .08 0.937 [0.877–0.968] 0.936 [0.875–0.967] - Table 3:
Diagnostic performance of the DCE pharmacokinetic parameters in detecting true progression
Pharmacokinetic Parameter T1 Method Median AUC Optimal Threshold Value Sensitivity [%] Specificity [%] P Valuea Ktrans, min−1 Fixed 0.694 0.093 53.3 86.4 .03b Measured 0.664 0.059 .08 Kep, min−1 Fixed 0.752 0.184 80.0 63.6 .002b Measured 0.603 0.159 .28 Vp, % Fixed 0.552 3.423 .62 Measured 0.609 0.597 .25 Ve Fixed 0.518 0.349 .86 Measured 0.606 0.546 .30 - Table 4:
Diagnostic performance of Kep from the fixed T1 and results from the leave-one-out cross-validation
Median AUC Optimal Threshold Value Sensitivity Specificity Accuracy Positive Predictive Value Negative Predictive Value 0.752 0.184 80.0% (12/15) 63.6% (14/22) 70.3% (26/37) 60.0% (12/20) 82.4% (14/17) Leave-one-out cross-validation 73.3% (11/15) 59.1% (13/22) 64.9% (24/37) 55.0% (11/20) 76.5% (13/17)
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