Perfusion MRI in treatment evaluation of glioblastomas: Clinical relevance of current and future techniques

Bart R J van Dijken, Peter Jan van Laar, Marion Smits, Jan Willem Dankbaar, Roelien H Enting, Anouk van der Hoorn*

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Pages (from-to)11-22
Number of pages12
JournalJournal of Magnetic Resonance Imaging
Volume49
Issue number1
DOIs
Publication statusPublished - Jan-2019

Keywords

  • glioblastoma
  • perfusion imaging
  • magnetic resonance imaging
  • treatment evaluation
  • HIGH-GRADE GLIOMAS
  • CEREBRAL BLOOD-VOLUME
  • RADIOTHERAPY PLUS CONCOMITANT
  • INTRAVOXEL INCOHERENT MOTION
  • SPIN-LABELING PERFUSION
  • MULTIPARAMETRIC MRI
  • CONCURRENT CHEMORADIOTHERAPY
  • RECURRENT GLIOBLASTOMA
  • COMPUTED-TOMOGRAPHY
  • RESPONSE ASSESSMENT

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