She/Her/Hers
Job Title
Research Trainee
Academic Rank
Undergraduate Student
Department
Radiology
Authors
Inga Krause*, Thomas Zeyen, MD, Andreas Decker, MSc, Florian Kroh, PhD, Sebastian Regnery, MD, Niklas Schaefer, MD, Johannes Weller, MD, Jochen Keupp, PhD, Christoph Katemann, MSc, Alexander Radbruch, MD, Ulrich Herrlinger, MD, Daniel Paech, MD, PhD
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Purpose: Therapy-related MRI changes are common in glioblastomas, yet they remain challenging to differentiate from true tumor progression. [1] Techniques like diffusion-weighted imaging (DWI), MRI perfusion and amino acid PET offer diagnostic support, but show limited sensitivity and specificity. Smaller studies suggest that amide proton transfer weighted (APTw) imaging can help differentiate therapy-related from progression-related MRI changes. [2]
Methods: 145 glioblastoma patients (IDH-wildtype, CNS WHO grade 4) with available APTw imaging at 3T were examined. In 61 patients with suspected progression according to the latest Response Assessment in Neuro-Oncology (RANO) criteria, a region of interest (ROI) was created in the contrast-enhancing areas of the T1w sequence using the “HD-GLIO” algorithm [3,4] and, if necessary, corrected manually. The mean APTw signal intensity in these ROIs was determined and compared using unpaired t-tests for confirmed progression (biopsy or clinical follow-up) and treatment-related MRI changes. A ROC analysis evaluated the sensitivity and specificity of APTw imaging for identifying pseudoprogression.
Results: The mean APTw signal intensity (%) was 2.36 in confirmed progressions and 1.56 in treatment-related MRI changes (p < 0.0003). Excluding cases affected by treatments impacting vascular permeability (primarily Bevacizumab), it was 2.48 vs. 1.54 (p < 0.0001). The ROC analysis showed an AUC of 0.87. With a cut-off of 2.10, the sensitivity for identifying pseudoprogression was 90.5% and the specificity 70.3%. Conclusion: APTw imaging has potential for detecting pseudoprogression in glioblastoma patients, but remains limited in specificity as a single method. Future studies should examine the combination of APTw imaging with other techniques (e.g., DWI) and confirm its potential in prospective analyses. References: 1. Wen PY, et al. J Clin Oncol. 2023;41(33):5187-5199. 2. Ma B, et al. J Magn Reson Imaging 2016;44(2):456-462. 3. Kickingereder P, et al. Lancet Oncol 2019;20(5):728-740. 4. Isensee F, et al. Nat Methods 2021;18:203–211.
