Glioblastom Tanısıyla Takip Edilen Hastalarda Hastalığın Gerçek Progresyonu ile Yalancı Progresyonun Ayrılmasında Manyetik Rezonans ile Difüzyon, Perfüzyon ve Permeabilite Görüntülemesi

Abstract

Glioblastoma is the most common primary central nervous system tumor in adults. They tend to show recurrence frequently during the treatment, leading to poor overall survival. Pseudoprogression (PsP) is seen as newly formed or increased enhancing lesion during the treatment, resulting in confusion with true disease progression (TP) in imaging modalities, and it can cause problems in the management of the patients. The newly formed or increased enhancing lesion frequently has components with various diffusion characteristics. In this study, we aimed to study corresponding enhancement and perfusion caharacteristics in these tissue components with varying diffusion features and to determine the lesion course in the follow-up study. We also aimed to look for the effectiviness of diffusion weighted imaging (DWI), perfusion and permeability imaging in terms of differentiation between TP and PsP. As a result, in a lesion with distinct diffusion properties, perfusion and permeability studies rather than DWI help to discriminate between TP and PsP. We also found that DWI has weak accuracy (Az 0.67) for the discrimination of DP and PsP, while perfusion and permebility values have good diagnostic accuracy (Az 0.84 ve 0.88, respectively). Combining perfusion and permeability imaging to DWI increases diagnostic accuracy, but no significant difference is present between perfusion or permeability imaging (p=0.243). Combining DWI with either perfusion or permeability imaging may improve patient managent by accurate differentiation of TP and PsP.