====== Glioblastoma Recurrence Differential Diagnosis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1ngYFTZ0OsNs0iZM_XH2u4FlRBOijGIXIVAeaTaKXuf37JXQ-w/?limit=15&utm_campaign=pubmed-2&fc=20240228173742}}

===== Dynamic Susceptibility Weighted Contrast-Enhanced Perfusion Imaging for glioblastoma recurrence diagnosis =====

[[Dynamic Susceptibility Weighted Contrast-Enhanced Perfusion Imaging for glioblastoma recurrence diagnosis]]

----

----

----

----


see [[Macdonald criteria]].

see [[RANO criteria]]


[[Radiation necrosis]] and other normal responses associated with surgical treatment may lead to mimicking of tumor recurrence, also known as [[glioblastoma pseudoprogression]]. 

[[Radionecrosis]] vs [[recurrent glioblastoma]]: Despite the fact that a history of prior [[radiation therapy]]
is usually know at the time of intraoperative consultation, differentiation of the two entities can
at times be difficult
((Plesec TP, Prayson RA. Frozen section discrepancy
in the evaluation of central nervous system tumors.
Arch Pathol Lab Med. 2007; 131:1532–1540)).

Both lesions often are present simultaneously. Identifying obvious tumor cells and palisading necrosis suggests recurrent/residual glioblastoma. Radiation necrosis, which affects primarily white matter, is supported by large areas of geographic necrosis, sclerosis/hyalinization of vessels or fibrinoid necrosis of vessel walls, perivascular lymphocytes, calcifications, and the presence of macrophages.
----
In the first couple of months it becomes difficult to differentiate recurrence from [[glioblastoma pseudoprogression]] using T2 weighted image, [[T1 weighted]] [[gadolinium]], fluid-attenuated inversion-recovery ([[FLAIR]]) sequence of MRI
((Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical features, 
mechanisms, and management of pseudoprogression in malignant gliomas. Lancet
Oncol. 2008 May;9(5):453-61. doi: 10.1016/S1470-2045(08)70125-6. Review. PubMed
PMID: 18452856.
)).
----
Single-photon emission computed tomography (SPECT), positron emission tomography (PET), perfusion CT, diffusion MRI, perfusion MRI, and magnetic resonance spectroscopy (MRS) are the imaging modalities in the clinical setting.

Determining whether glioblastoma multiforme (Glioblastoma) is progressing despite treatment is challenging due to the pseudoprogression in glioblastoma phenomenon seen on conventional MRIs, but [[relative cerebral blood volume]] (CBV) has been shown to be helpful.

Adding [[perfusion MRI]] imaging to the combination of [[Dynamic contrast enhanced MRI]] CE contrast enhanced T1-weighted imaging and [[Diffusion weighted magnetic resonance imaging]] significantly improves the prediction of recurrent glioblastoma; however, selection of [[perfusion MRI]] method does not affect the diagnostic performance
((Kim HS, Goh MJ, Kim N, Choi CG, Kim SJ, Kim JH. Which combination of MR
imaging modalities is best for predicting recurrent glioblastoma? Study of
diagnostic accuracy and reproducibility. Radiology. 2014 Dec;273(3):831-43. doi: 
10.1148/radiol.14132868. Epub 2014 May 30. PubMed PMID: 24885857.)).

The multiparametric 3-T MR assessment based on [[Proton magnetic resonance spectroscopic imaging]] (Proton magnetic resonance spectroscopic imagingI), [[diffusion weighted imaging]] (DWI) and [[perfusion weighted imaging]] (PWI) in addition to MRI is a useful tool to discriminate tumour recurrence/progression from radiation effects ((Di Costanzo A, Scarabino T, Trojsi F, Popolizio T, Bonavita S, de Cristofaro
M, Conforti R, Cristofano A, Colonnese C, Salvolini U, Tedeschi G. Recurrent
glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR
approach. Radiol Med. 2014 Jan 10. [Epub ahead of print] PubMed PMID: 24408041.)).

The regional cerebral blood volume (rCBVmax) in [[Perfusion MRI]] differentiates tumor progression from Treatment-related changes (TRC) in unselected recurrent glioblastomas, but it is not predictive for the overall survival (OS)
((Blasel S, Zagorcic A, Jurcoane A, Bähr O, Wagner M, Harter PN, Hattingen E.
Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence. J
Neuroimaging. 2015 Apr 24. doi: 10.1111/jon.12247. [Epub ahead of print] PubMed
PMID: 25907688.
)).
----
Adding and combining proton MR spectroscopic imaging (Proton magnetic resonance spectroscopic imagingI), diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) information at 3 Tesla facilitate such discrimination ((Di Costanzo A, Scarabino T, Trojsi F, Popolizio T, Bonavita S, de Cristofaro
M, Conforti R, Cristofano A, Colonnese C, Salvolini U, Tedeschi G. Recurrent
glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR
approach. Radiol Med. 2014 Jan 10. [Epub ahead of print] PubMed PMID: 24408041.
)).

===== References =====