Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide: Comparison study of standard and high-b-value diffusion-weighted imaging

Hee Ho Chu, Seung Hong Choi, Inseon Ryoo, Soo Chin Kim, Jeong A. Yeom, Hwaseon Shin, Seung Chai Jung, A. Leum Lee, Tae Jin Yoon, Tae Min Kim, Se Hoon Lee, Chul Kee Park, Ji Hoon Kim, Chul Ho Sohn, Sung Hye Park, Il Han Kim

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Abstract

Purpose: To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained at standard-and high-b-value (1000 and 3000 sec/mm2, respectively) diffusion-weighted (DW) imaging in the differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide. Materials and Methods: This retrospective study was approved by the institutional review board of Seoul National University Hospital, and informed consent requirement was waived. Thirty patients with histopathologically proved glioblastoma who had undergone concurrent chemotherapy and radiation therapy (CCRT) with temozolomide underwent diffusion-weighted MR imaging with b values of 1000 and 3000 sec/mm2, and corresponding ADC maps were calculated from entire newly developed or enlarged enhancing lesions after completion of CCRT. Histogram parameters of each ADC map between true progression (n = 15) and pseudoprogression (n = 15) groups were compared by using the unpaired Student t test. Receiver operating characteristic analysis was used to determine the best cutoff values for predictors in the differentiation of true progression from pseudoprogression. Results were validated in an independent test set of nine patients by using the best cutoff value to predict differentiation of true progression from pseudoprogression. The accuracy of the selected best cutoff value in the independent test set was then calculated. Results: In terms of cumulative histograms, the fifth percentile of both ADC at b value of 1000 sec/mm2 (ADC1000) and the ADC at b value of 3000 sec/ mm2 (ADC3000) were significantly lower in the true progression group than in the pseudoprogression group (P = .049 and P < .001, respectively). In contrast, neither the mean ADC1000 nor the mean ADC3000 was significantly different between the two groups. The diagnostic values of the parameters derived from ADC1000 and ADC 3000 were compared, and a significant difference (0.224, P = .016) was found between the area under the receiver operating characteristic curve of the fifth percentile for ADC1000 and that for ADC3000. The accuracies were 66.7% (six of nine patients) and 88.9% (eight of nine patients) based on the fifth percentile of both ADC1000 and ADC3000 in the independent test set, respectively. Conclusion: The fifth percentile of the cumulative ADC histogram obtained at a high b value was the most promising parameter in the differentiation of true progression from pseudoprogression of the newly developed or enlarged enhancing lesions after CCRT with temozolomide for glioblastoma treatment.

Original languageEnglish
Pages (from-to)831-840
Number of pages10
JournalRadiology
Volume269
Issue number3
DOIs
Publication statusPublished - 2013 Dec 1
Externally publishedYes

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temozolomide
Glioblastoma
Radiotherapy
Drug Therapy
ROC Curve
Research Ethics Committees

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide : Comparison study of standard and high-b-value diffusion-weighted imaging. / Chu, Hee Ho; Choi, Seung Hong; Ryoo, Inseon; Kim, Soo Chin; Yeom, Jeong A.; Shin, Hwaseon; Jung, Seung Chai; Lee, A. Leum; Yoon, Tae Jin; Kim, Tae Min; Lee, Se Hoon; Park, Chul Kee; Kim, Ji Hoon; Sohn, Chul Ho; Park, Sung Hye; Kim, Il Han.

In: Radiology, Vol. 269, No. 3, 01.12.2013, p. 831-840.

Research output: Contribution to journalArticle

Chu, HH, Choi, SH, Ryoo, I, Kim, SC, Yeom, JA, Shin, H, Jung, SC, Lee, AL, Yoon, TJ, Kim, TM, Lee, SH, Park, CK, Kim, JH, Sohn, CH, Park, SH & Kim, IH 2013, 'Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide: Comparison study of standard and high-b-value diffusion-weighted imaging', Radiology, vol. 269, no. 3, pp. 831-840. https://doi.org/10.1148/radiol.13122024
Chu, Hee Ho ; Choi, Seung Hong ; Ryoo, Inseon ; Kim, Soo Chin ; Yeom, Jeong A. ; Shin, Hwaseon ; Jung, Seung Chai ; Lee, A. Leum ; Yoon, Tae Jin ; Kim, Tae Min ; Lee, Se Hoon ; Park, Chul Kee ; Kim, Ji Hoon ; Sohn, Chul Ho ; Park, Sung Hye ; Kim, Il Han. / Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide : Comparison study of standard and high-b-value diffusion-weighted imaging. In: Radiology. 2013 ; Vol. 269, No. 3. pp. 831-840.
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abstract = "Purpose: To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained at standard-and high-b-value (1000 and 3000 sec/mm2, respectively) diffusion-weighted (DW) imaging in the differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide. Materials and Methods: This retrospective study was approved by the institutional review board of Seoul National University Hospital, and informed consent requirement was waived. Thirty patients with histopathologically proved glioblastoma who had undergone concurrent chemotherapy and radiation therapy (CCRT) with temozolomide underwent diffusion-weighted MR imaging with b values of 1000 and 3000 sec/mm2, and corresponding ADC maps were calculated from entire newly developed or enlarged enhancing lesions after completion of CCRT. Histogram parameters of each ADC map between true progression (n = 15) and pseudoprogression (n = 15) groups were compared by using the unpaired Student t test. Receiver operating characteristic analysis was used to determine the best cutoff values for predictors in the differentiation of true progression from pseudoprogression. Results were validated in an independent test set of nine patients by using the best cutoff value to predict differentiation of true progression from pseudoprogression. The accuracy of the selected best cutoff value in the independent test set was then calculated. Results: In terms of cumulative histograms, the fifth percentile of both ADC at b value of 1000 sec/mm2 (ADC1000) and the ADC at b value of 3000 sec/ mm2 (ADC3000) were significantly lower in the true progression group than in the pseudoprogression group (P = .049 and P < .001, respectively). In contrast, neither the mean ADC1000 nor the mean ADC3000 was significantly different between the two groups. The diagnostic values of the parameters derived from ADC1000 and ADC 3000 were compared, and a significant difference (0.224, P = .016) was found between the area under the receiver operating characteristic curve of the fifth percentile for ADC1000 and that for ADC3000. The accuracies were 66.7{\%} (six of nine patients) and 88.9{\%} (eight of nine patients) based on the fifth percentile of both ADC1000 and ADC3000 in the independent test set, respectively. Conclusion: The fifth percentile of the cumulative ADC histogram obtained at a high b value was the most promising parameter in the differentiation of true progression from pseudoprogression of the newly developed or enlarged enhancing lesions after CCRT with temozolomide for glioblastoma treatment.",
author = "Chu, {Hee Ho} and Choi, {Seung Hong} and Inseon Ryoo and Kim, {Soo Chin} and Yeom, {Jeong A.} and Hwaseon Shin and Jung, {Seung Chai} and Lee, {A. Leum} and Yoon, {Tae Jin} and Kim, {Tae Min} and Lee, {Se Hoon} and Park, {Chul Kee} and Kim, {Ji Hoon} and Sohn, {Chul Ho} and Park, {Sung Hye} and Kim, {Il Han}",
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TY - JOUR

T1 - Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide

T2 - Comparison study of standard and high-b-value diffusion-weighted imaging

AU - Chu, Hee Ho

AU - Choi, Seung Hong

AU - Ryoo, Inseon

AU - Kim, Soo Chin

AU - Yeom, Jeong A.

AU - Shin, Hwaseon

AU - Jung, Seung Chai

AU - Lee, A. Leum

AU - Yoon, Tae Jin

AU - Kim, Tae Min

AU - Lee, Se Hoon

AU - Park, Chul Kee

AU - Kim, Ji Hoon

AU - Sohn, Chul Ho

AU - Park, Sung Hye

AU - Kim, Il Han

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Purpose: To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained at standard-and high-b-value (1000 and 3000 sec/mm2, respectively) diffusion-weighted (DW) imaging in the differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide. Materials and Methods: This retrospective study was approved by the institutional review board of Seoul National University Hospital, and informed consent requirement was waived. Thirty patients with histopathologically proved glioblastoma who had undergone concurrent chemotherapy and radiation therapy (CCRT) with temozolomide underwent diffusion-weighted MR imaging with b values of 1000 and 3000 sec/mm2, and corresponding ADC maps were calculated from entire newly developed or enlarged enhancing lesions after completion of CCRT. Histogram parameters of each ADC map between true progression (n = 15) and pseudoprogression (n = 15) groups were compared by using the unpaired Student t test. Receiver operating characteristic analysis was used to determine the best cutoff values for predictors in the differentiation of true progression from pseudoprogression. Results were validated in an independent test set of nine patients by using the best cutoff value to predict differentiation of true progression from pseudoprogression. The accuracy of the selected best cutoff value in the independent test set was then calculated. Results: In terms of cumulative histograms, the fifth percentile of both ADC at b value of 1000 sec/mm2 (ADC1000) and the ADC at b value of 3000 sec/ mm2 (ADC3000) were significantly lower in the true progression group than in the pseudoprogression group (P = .049 and P < .001, respectively). In contrast, neither the mean ADC1000 nor the mean ADC3000 was significantly different between the two groups. The diagnostic values of the parameters derived from ADC1000 and ADC 3000 were compared, and a significant difference (0.224, P = .016) was found between the area under the receiver operating characteristic curve of the fifth percentile for ADC1000 and that for ADC3000. The accuracies were 66.7% (six of nine patients) and 88.9% (eight of nine patients) based on the fifth percentile of both ADC1000 and ADC3000 in the independent test set, respectively. Conclusion: The fifth percentile of the cumulative ADC histogram obtained at a high b value was the most promising parameter in the differentiation of true progression from pseudoprogression of the newly developed or enlarged enhancing lesions after CCRT with temozolomide for glioblastoma treatment.

AB - Purpose: To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained at standard-and high-b-value (1000 and 3000 sec/mm2, respectively) diffusion-weighted (DW) imaging in the differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide. Materials and Methods: This retrospective study was approved by the institutional review board of Seoul National University Hospital, and informed consent requirement was waived. Thirty patients with histopathologically proved glioblastoma who had undergone concurrent chemotherapy and radiation therapy (CCRT) with temozolomide underwent diffusion-weighted MR imaging with b values of 1000 and 3000 sec/mm2, and corresponding ADC maps were calculated from entire newly developed or enlarged enhancing lesions after completion of CCRT. Histogram parameters of each ADC map between true progression (n = 15) and pseudoprogression (n = 15) groups were compared by using the unpaired Student t test. Receiver operating characteristic analysis was used to determine the best cutoff values for predictors in the differentiation of true progression from pseudoprogression. Results were validated in an independent test set of nine patients by using the best cutoff value to predict differentiation of true progression from pseudoprogression. The accuracy of the selected best cutoff value in the independent test set was then calculated. Results: In terms of cumulative histograms, the fifth percentile of both ADC at b value of 1000 sec/mm2 (ADC1000) and the ADC at b value of 3000 sec/ mm2 (ADC3000) were significantly lower in the true progression group than in the pseudoprogression group (P = .049 and P < .001, respectively). In contrast, neither the mean ADC1000 nor the mean ADC3000 was significantly different between the two groups. The diagnostic values of the parameters derived from ADC1000 and ADC 3000 were compared, and a significant difference (0.224, P = .016) was found between the area under the receiver operating characteristic curve of the fifth percentile for ADC1000 and that for ADC3000. The accuracies were 66.7% (six of nine patients) and 88.9% (eight of nine patients) based on the fifth percentile of both ADC1000 and ADC3000 in the independent test set, respectively. Conclusion: The fifth percentile of the cumulative ADC histogram obtained at a high b value was the most promising parameter in the differentiation of true progression from pseudoprogression of the newly developed or enlarged enhancing lesions after CCRT with temozolomide for glioblastoma treatment.

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