Diagnostic Dilemma of Pseudoprogression in the Treatment of Newly Diagnosed Glioblastomas: The Role of Assessing Relative Cerebral Blood Flow Volume and Oxygen-6-Methylguanine-DNA Methyltransferase Promoter Methylation Status
Diagnostic Dilemma of Pseudoprogression in the Treatment of Newly Diagnosed Glioblastomas: The Role of Assessing Relative Cerebral Blood Flow Volume and Oxygen-6-Methylguanine-DNA Methyltransferase Promoter Methylation Status
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DOI：
10.3174/ajnr.a2286
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发表时间：
2011-02-01
影响因子：
3.5
通讯作者：
Nam, D. -H.
中科院分区：
文献类型：
--
作者：
Kong, D. -S.;Kim, S. T.;Nam, D. -H.
背景和目的：MGMT 基因启动子的甲基化与接受 TMZ 治疗的成年 GBM 患者的良好预后相关。我们根据 MGMT 甲基化状态和 DSC 灌注 MR 图像预测假性进展的潜在价值来确定假性进展的发生率。 材料和方法：通过使用 DSC 灌注 MR 图像测量 rCBV 来前瞻性评估新诊断 GBM 成年患者 CCRT 后新发或扩大的强化病灶。分析肿瘤组织以确定 MGMT 启动子甲基化状态。所有患者均以 2 个月的间隔定期进行 MR 图像随访，包括 DSC 灌注 MR 图像。 结果：90 名符合条件的患者纳入本研究。 CCRT后，90例患者中有59例发现新的或扩大的强化病灶，随后分为假进展（26例，28.9%）和真进展（33例，36.7%）。总体而言，假性进展和真实肿瘤进展之间的平均 rCBV 存在显着差异 (P = .003)。 ROC 曲线显示 rCBV 比率 >1.47 的敏感性为 81.5%，特异性为 77.8%。未甲基化 MGMT 启动子组的假性进展和真实进展之间的平均 rCBV 存在显着差异 (P = .009)，而甲基化 MGMT 启动子组没有显着差异 (P = .258)。 结论：当前研究表明，通过 DSC 灌注 MR 图像测量的 rCBV 对 GBM 患者假性进展的可预测性具有不同的影响。
BACKGROUND AND PURPOSE: Methylation of the MGMT gene promoter is associated with a favorable prognosis in adult patients with GBM treated with TMZ. We determined the incidence of pseudoprogression according to the MGMT methylation status and the potential value of DSC perfusion MR images for predicting pseudoprogression.MATERIALS AND METHODS: New or enlarged enhancing lesions after CCRT in adult patients with newly diagnosed GBMs were prospectively assessed by measuring their rCBV by using DSC perfusion MR images. Tumor tissue was assayed to determine MGMT promoter methylation status. All patients were regularly followed up at an interval of 2 months by MR images, including DSC perfusion MR images.RESULTS: Ninety eligible patients were enrolled in this study. After CCRT, new or enlarged enhanced lesions were found in 59 of 90 patients, which were subsequently classified as pseudoprogression (26 patients, 28.9%) and real progression (33 patients, 36.7%). Overall, there was a significant difference in the mean rCBV between pseudoprogression and real tumor progression (P = .003). The ROC curve revealed that an rCBV ratio >1.47 had an 81.5% sensitivity and a 77.8% specificity. The unmethylated MGMT promoter group had a significant difference of mean rCBV between pseudoprogression and real progression (P = .009), though the methylated MGMT promoter group had no significant difference (P = .258).CONCLUSIONS: The current study suggests that rCBV measured by DSC perfusion MR images has a differential impact on the predictability of pseudoprogression in patients with GBM.