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<meta name="DC.Title" content="Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6984" />
<meta name="DC.Date" content="2021-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2021 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.

MATERIALS AND METHODS: Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.

RESULTS: There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (−0.02 versus 0.33, P = .02) and a lower arterial dominance score (1.46 versus 2.11, P = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, P = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, P = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70–0.94; P = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49–0.79) in distinguishing early tumor progression from pseudoprogression.

CONCLUSIONS: Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.

AUC
:   area under the curve
ETP
:   early tumor progression
CCRT
:   concurrent chemoradiotherapy
GRE
:   gradient recalled-echo
PP
:   pseudoprogression
rCBV
:   relative CBV
rVSI
:   relative vessel size index
SE
:   spin-echo
VAI
:   vessel architectural imaging" />
<meta name="DC.Contributor" content="M. Kim" />
<meta name="DC.Contributor" content="J.E. Park" />
<meta name="DC.Contributor" content="K. Emblem" />
<meta name="DC.Contributor" content="A Bjørnerud" />
<meta name="DC.Contributor" content="H.S. Kim" />
<meta name="article:published_time" content="2021-04-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (−0.02 versus 0.33, &lt;i&gt;P&lt;/i&gt; = .02) and a lower arterial dominance score (1.46 versus 2.11, &lt;i&gt;P&lt;/i&gt; = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, &lt;i&gt;P&lt;/i&gt; = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, &lt;i&gt;P&lt;/i&gt; = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70–0.94; &lt;i&gt;P&lt;/i&gt; = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49–0.79) in distinguishing early tumor progression from pseudoprogression.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.&lt;/p&gt;" />
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<meta name="twitter:title" content="Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.

MATERIALS AND METHODS: Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.

RESULTS: There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (−0.02 versus 0.33, P = .02) and a lower arterial dominance score (1.46 versus 2.11, P = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, P = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, P = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70–0.94; P = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49–0.79) in distinguishing early tumor progression from pseudoprogression.

CONCLUSIONS: Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.

AUC
:   area under the curve
ETP
:   early tumor progression
CCRT
:   concurrent chemoradiotherapy
GRE
:   gradient recalled-echo
PP
:   pseudoprogression
rCBV
:   relative CBV
rVSI
:   relative vessel size index
SE
:   spin-echo
VAI
:   vessel architectural imaging" />
<meta name="og-title" property="og:title" content="Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/42/4/663" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.

MATERIALS AND METHODS: Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.

RESULTS: There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (−0.02 versus 0.33, P = .02) and a lower arterial dominance score (1.46 versus 2.11, P = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, P = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, P = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70–0.94; P = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49–0.79) in distinguishing early tumor progression from pseudoprogression.

CONCLUSIONS: Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.

AUC
:   area under the curve
ETP
:   early tumor progression
CCRT
:   concurrent chemoradiotherapy
GRE
:   gradient recalled-echo
PP
:   pseudoprogression
rCBV
:   relative CBV
rVSI
:   relative vessel size index
SE
:   spin-echo
VAI
:   vessel architectural imaging" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node90316--7" data-node-nid="90316" id="top-node-90316--81031544988" data-pisa="ajnr;42/4/663" data-pisa-master="ajnr;ajnr.A6984" data-apath="/ajnr/42/4/663.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Kim</span>, <span class="highwire-citation-author" data-delta="1">J.E. Park</span>, <span class="highwire-citation-author" data-delta="2">K. Emblem</span>, <span class="highwire-citation-author" data-delta="3">A Bjørnerud</span> and <span class="highwire-citation-author" data-delta="4">H.S. Kim</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2021,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">42 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">663-670; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6984 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-90316--81031544988" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5382-9360" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Kim</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.E. Park </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.E.%2BPark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Park%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.E.%2BPark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4419-4682" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.E. Park</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K. Emblem </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Diagnostic Physics, (K.E.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BEmblem%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Emblem%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BEmblem%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6580-9519" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Emblem</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A Bjørnerud </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Unit for Computational Radiology and Artificial Intelligence (A.B.), Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Physics (A.B.), University of Oslo, Oslo, Norway</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A%2BBj%C3%B8rnerud%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bj%C3%B8rnerud%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA%2BBj%25C3%25B8rnerud%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3486-3141" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A Bjørnerud</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">H.S. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.S.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.S.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9477-7421" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H.S. Kim</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">M. Kim</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">J.E. Park</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">K. Emblem</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">A Bjørnerud</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a><span class="xref-sep">,</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a> and </li><li class="last" id="contrib-5"><span class="name">H.S. Kim</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Department of Diagnostic Physics, (K.E.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Unit for Computational Radiology and Artificial Intelligence (A.B.), Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of Physics (A.B.), University of Oslo, Oslo, Norway</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Ji Eun Park, MD, PhD, <span class="addr-line">Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul 05505, South Korea</span>; e-mail: <span class="em-link"><span class="em-addr">jieunp{at}gmail.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/42/4/663.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.E.</span> <span class="nlm-surname">Park</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Emblem</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A</span> <span class="nlm-surname">Bjørnerud</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">H.S.</span> <span class="nlm-surname">Kim</span></span></span></div>
  
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      <div class="highwire-cite-title">Vessel Type Determined by Vessel Architectural Imaging Improves Differentiation between Early Tumor Progression and Pseudoprogression in Glioblastoma</div>  
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