Artikel
CT perfusion imaging and MGMT promoter methylation in patients with glioblastoma multiforme – recurrence versus pseudoprogression
CT Perfusionsbildgebung und MGMT-Promotormethylierung bei Patienten mit Glioblastoma multiforme – Rezidiv versus Pseudoprogression
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Despite complete resection tumor recurrence occurs in most patients suffering from glioblastoma. Reliable imaging to differentiate between tumor recurrence and pseudoprogression following therapy is not available. Few studies showed a significant correlation between MGMT promoter methylation and occurrence of pseudoprogression. Aim of this study was to analyze the role of CT perfusion imaging as a diagnostic tool for recurrence in patients with glioblastoma and the impact of MGMT status on its sensitivity and specificity.
Methods: A retrospective analysis was performed for patients with glioblastoma multiforme and existing CT perfusion imaging for suspected recurrence. All patients were treated with standard combined radiochemotherapy after surgical resection at primary diagnosis. Recurrence or pseudoprogression respectively was either confirmed histologically, by follow-up MRI imaging (RANO criteria) or by clinical course. Sensitivity and specificity of CT Perfusion imaging were evaluated and compared between patients with and without MGMT promoter methylation.
Results: 43 patients with a mean age of 57 years (range 31–77y) were included in the analysis. The mean time between completed radiochemotherapy and CT perfusion scan was 8.6 months. In 13/42 (31%) cases histologically, in 20/43 (46%) cases by MRI scan and in 10/43 (23%) cases by clinical course recurrent tumor was confirmed in 29/43 (67%) patients and pseudoprogression in 14/43 (33%) patients. Information about MGMT promoter methylation was available for 27/43 (63%) patients. 11/27 (40%) patients were MGMT positive and 16/27 (60%) patients were MGMT negative.
Sensitivity and specificity of CT perfusion imaging was 76.5% and 37.5% respectively. For patients with MGMT promoter methylation sensitivity of CT perfusion imaging was 50% and specificity was 33,3%. For patients without MGMT promoter methylation sensitivity was 78.6% and specificity 100%. Correlation between MGMT promoter methylation and validity of CT perfusion were not statistically significant (p>.05)
Conclusion: In the present pilot cohort, sensitivity and specificity of CT perfusion imaging to differentiate between recurrence and pseudoprogression was comparatively low. However, validity of CTP perfusion measurement might be related to tumor genetics.