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Arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) have shown potential for differentiating tumor progression from pseudoprogression. For pseudocontinuous ASL with a single postlabeling delay, the presence of delayed arterial transit times (ATTs) could affect the evaluation of ASL-MRI perfusion data. In this study, the influence of ATT artifacts on the perfusion assessment and differentiation between tumor progression and pseudoprogression were studied. This study comprised 66 adult patients (mean age 60 ± 13 years; 40 males) with a histologically confirmed glioblastoma who received postoperative radio (chemo)therapy. ASL-MRI and DSC-MRI scans were acquired at 3 months postradiotherapy as part of the standard clinical routine. These scans were visually scored regarding (i) the severity of ATT artifacts (%) on the ASL-MRI scans only, scored by two neuroradiologists; (ii) perfusion of the enhancing tumor lesion; and (iii) radiological evaluation of tumor progression versus pseudoprogression by one neuroradiologist. The final outcome was based on combined clinical and radiological follow-up until 9 months postradiotherapy. ATT artifacts were identified in all patients based on the mean scores of two raters. A significant difference between the radiological evaluation of ASL-MRI and DSC-MRI was observed only for ASL images with moderate ATT severity (30%-65%). The perfusion assessment showed ASL-MRI tending more towards hyperperfusion than DSC-MRI in the case of moderate ATT artifacts. In addition, there was a significant difference between the prediction of tumor progression with ASL-MRI and the final outcome in the case of severe ATT artifacts (McNemar test, p = 0.041). Despite using ASL imaging parameters close to the recommended settings, ATT artifacts frequently occur in patients with treated brain tumors. Those artifacts could hinder the radiological evaluation of ASL-MRI data and the detection of true disease progression, potentially affecting treatment decisions for patients with glioblastoma.

Titel:	Influence of arterial transit time delays on the differentiation between tumor progression and pseudoprogression in glioblastoma by arterial spin labeling magnetic resonance imaging.
Autor/in / Beteiligte Person:	van Dorth D ; Jiang, FY ; Schmitz-Abecassis, B ; Croese, RJI ; Taphoorn, MJB ; Smits, M ; Koekkoek, JAF ; Dirven, L ; de Bresser J ; van Osch MJP
Link:	Full Text Finder (Volltext)
Zeitschrift:	NMR in biomedicine, 2024-04-23, S. e5166
Veröffentlichung:	Ahead of Print, 2024
Medientyp:	academicJournal
ISSN:	1099-1492 (electronic)
DOI:	10.1002/nbm.5166
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [NMR Biomed] 2024 Apr 23, pp. e5166. <i>Date of Electronic Publication: </i>2024 Apr 23. References: Sheikh S, Radivoyevitch T, Barnholtz‐Sloan JS, Vogelbaum M. Long‐term trends in glioblastoma survival: implications for historical control groups in clinical trials. Neurooncol Pract. 2020;7(2):158‐163. doi:10.1093/NOP/NPZ046. ; Verma N, Cowperthwaite MC, Burnett MG, Markey MK. Differentiating tumor recurrence from treatment necrosis: a review of neuro‐oncologic imaging strategies. Neuro Oncol. 2013;15(5):515‐534. doi:10.1093/NEUONC/NOS307. ; Fatterpekar GM, Galheigo D, Narayana A, Johnson G, Knopp E. Treatment‐related change versus tumor recurrence in high‐grade gliomas: a diagnostic conundrum—use of dynamic susceptibility contrast‐enhanced (DSC) perfusion MRI. Am J Roentgenol. 2012;198(1):19‐26. doi:10.2214/AJR.11.7417. ; Le Fèvre C, Lhermitte B, Ahle G, et al. 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Grant Information: project number 17079 Nederlandse Organisatie voor Wetenschappelijk Onderzoek; project number 17079 Nederlandse Organisatie voor Wetenschappelijk Onderzoek Contributed Indexing: Keywords: arterial spin labeling; arterial transit time; glioblastoma; perfusion MRI; pseudoprogression; tumor progression Entry Date(s): Date Created: 20240424 Latest Revision: 20240424 Update Code: 20240425

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Influence of arterial transit time delays on the differentiation between tumor progression and pseudoprogression in glioblastoma by arterial spin labeling magnetic resonance imaging.