Review Article

Clinical Applications of Contrast-Enhanced Perfusion MRI Techniques in Gliomas: Recent Advances and Current Challenges

Table 5

Differentiation of pseudoprogression from true progression.

Study (year) (ref)Group ()Average age (year)Imaging modality (method or model; parameter analysis)IndexesThreshold (Sp%, Sn%)limitations

Mangla et al. (2010) [150]PsP (7) 
TP (12)
61DSC-MRI (algorithm for leakage effect correction; ROI-based analysis)rCBVPercentage change in rCBV for discrimination of PsP and TP (85.7%, 76.9%)Retrospective; different treatment management; small sample size

Martínez-Martínez and Martínez-Bosch (2014) [151]PsP (17) 
TP (7)
48DSR-MRI (leakage effect uncorrected; ROI-based analysis)rCBV  
rPSR 
rPH
rPH = 1.37 (82.2%, 88%) 
rCBV = 0.9 (100%, 100%) 
rPSR = 99% (70.6%, 100%)
Retrospective; small sample size; impact of corticoid therapy on parameter evaluation; lack of histological confirmation

Prager et al. (2015) [152]PsP (8) 
TP (43)
55DSC-MRI (γ-variate function for leakage correction; ROI-based analysis)rCBV
rCBV
rCBV = 1.07 (75%, 100%) 
rCBV = 1.74 (75%, 92.9%)
Retrospective; small sample size of PsP; MGMT in some patients may affect the perfusion parameters

Baek et al. (2012) [153]PsP (37) 
TP (42)
49DSC-MRI (γ-variate function for leakage correction; histogram analysis)nCBVPercent change of skewness: 1.27% (79.2%, 85.7%) 
Percent change of kurtosis: 14% (73.0%, 61.9%)
Different therapies in patients; results were obtained from only one observer

Tsien et al. (2010) [154]PsP (13) 
TP (14)
52DSC-MRI (leakage effect uncorrected, parametric response map)rCBV  
rCBF
Not provided; patients with progressive had reduced rCBVLeakage effect may underestimate rCBV value

Gahramanov et al. (2013) [155]PsP (9) 
TP (10)
N/ADSC-MRI (ferumoxytol for leakage correction)rCBVrCBV = 1.5 (Sp%, Sn% not provided)Lack of histopathologic confirmation; small sample size

Suh et al. (2013) [156]PsP (36) 
TP (43)
50DCE-MRI (nonmodel fitting; histogram analysis)AUCR  
mAUCR
mAUCR = 0.31 (82.9%, 90.1%) 
AUC50 = 0.19 (83.1%, 87.2%)
Lack of correlation between imaging measurements and specimen histology

Yun et al. (2015) [157]PsP (16) 
TP (17)
55DCE-MRI (ETK model; histogram analysis)

= 0.347 (94%, 59%) 
= 0.570 (56%, 88%) 
No significant difference of between PsP and TP group
Small relative sample size; lack of histological confirmation