TY - JOUR
T1 - Perfusion MRI in treatment evaluation of glioblastomas
T2 - Clinical relevance of current and future techniques
AU - van Dijken, Bart R.J.
AU - van Laar, Peter Jan
AU - Smits, Marion
AU - Dankbaar, Jan Willem
AU - Enting, Roelien H.
AU - van der Hoorn, Anouk
N1 - Funding Information:
We thank dr. Hildebrand Dijkstra for providing the illustrative IVIM diffusion-weighted MRI case of Fig.
Publisher Copyright:
© 2018 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Treatment evaluation of patients with glioblastomas is important to aid in clinical decisions. Conventional MRI with contrast is currently the standard method, but unable to differentiate tumor progression from treatment-related effects. Pseudoprogression appears as new enhancement, and thus mimics tumor progression on conventional MRI. Contrarily, a decrease in enhancement or edema on conventional MRI during antiangiogenic treatment can be due to pseudoresponse and is not necessarily reflective of a favorable outcome. Neovascularization is a hallmark of tumor progression but not for posttherapeutic effects. Perfusion-weighted MRI provides a plethora of additional parameters that can help to identify this neovascularization. This review shows that perfusion MRI aids to identify tumor progression, pseudoprogression, and pseudoresponse. The review provides an overview of the most applicable perfusion MRI methods and their limitations. Finally, future developments and remaining challenges of perfusion MRI in treatment evaluation in neuro-oncology are discussed. Level of Evidence: 3. Technical Efficacy: Stage 4. J. Magn. Reson. Imaging 2019;49:11–22.
AB - Treatment evaluation of patients with glioblastomas is important to aid in clinical decisions. Conventional MRI with contrast is currently the standard method, but unable to differentiate tumor progression from treatment-related effects. Pseudoprogression appears as new enhancement, and thus mimics tumor progression on conventional MRI. Contrarily, a decrease in enhancement or edema on conventional MRI during antiangiogenic treatment can be due to pseudoresponse and is not necessarily reflective of a favorable outcome. Neovascularization is a hallmark of tumor progression but not for posttherapeutic effects. Perfusion-weighted MRI provides a plethora of additional parameters that can help to identify this neovascularization. This review shows that perfusion MRI aids to identify tumor progression, pseudoprogression, and pseudoresponse. The review provides an overview of the most applicable perfusion MRI methods and their limitations. Finally, future developments and remaining challenges of perfusion MRI in treatment evaluation in neuro-oncology are discussed. Level of Evidence: 3. Technical Efficacy: Stage 4. J. Magn. Reson. Imaging 2019;49:11–22.
KW - glioblastoma
KW - magnetic resonance imaging
KW - perfusion imaging
KW - treatment evaluation
KW - Reproducibility of Results
KW - Brain Neoplasms/diagnostic imaging
KW - Contrast Media/pharmacology
KW - Humans
KW - Magnetic Resonance Angiography/methods
KW - Disease Progression
KW - Edema/diagnostic imaging
KW - Glioblastoma/diagnostic imaging
KW - Brain/diagnostic imaging
KW - Neuroimaging/methods
KW - Image Processing, Computer-Assisted/methods
UR - http://www.scopus.com/inward/record.url?scp=85058679602&partnerID=8YFLogxK
U2 - 10.1002/jmri.26306
DO - 10.1002/jmri.26306
M3 - Article
C2 - 30561164
AN - SCOPUS:85058679602
SN - 1053-1807
VL - 49
SP - 11
EP - 22
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 1
ER -