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Objective <p>To evaluate the diagnostic accuracy of CMRO<sub>2</sub> (cerebral metabolic rate of oxygen) in differentiating between pseudoprogression and true tumour progression in patients with glioblastoma (GB) following chemoradiotherapy and to compare its performance with rCBV (relative cerebral blood volume).</p> Materials and methods <p>This diagnostic accuracy study included two cohorts: an analysis group (32 patients, 19 progression, 13 pseudoprogression) and a validation group (52 patients, 35 progression, 17 pseudoprogression). Patients underwent MRI (magnetic resonance imaging) with DSC (dynamic susceptibility contrast) and DCE (dynamic contrast-enhanced) perfusion imaging. CMRO<sub>2</sub> and rCBV thresholds were evaluated to calculate sensitivity, specificity, and area under the curve (AUC). Inclusion criteria were GB diagnosis, standard chemoradiotherapy, and new or enlarged enhancing lesions on MRI within one year.</p> Results <p>In the analysis group (mean age, 60.8 ± 8&#xa0;years), CMRO<sub>2</sub> showed superior performance with an AUC of 0.89 (95% CI 0.77–0.98), sensitivity of 84.2%, and specificity of 83.3%. rCBV achieved an AUC of 0.63 (95% CI 0.42–0.88). In the validation group (mean age, 63 ± 7&#xa0;years), CMRO<sub>2</sub> maintained an AUC of 0.91 (95% CI 0.82–0.98), while rCBV reached an AUC of 0.79 (95% CI 0.65–0.91). The DeLong test confirmed CMRO<sub>2</sub>'s significantly higher performance (<i>p</i> = 0.04).</p> Conclusion <p>CMRO<sub>2</sub> demonstrates higher diagnostic performance than rCBV in distinguishing pseudoprogression from true progression in GB patients. Despite limitations, CMRO<sub>2</sub> shows promise as a non-invasive biomarker, warranting further multicentre validation.</p>

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CMRO2 (DSC-PW) perfusion parameter helps to distinguish between progression and pseudoprogression in patients with glioblastoma

  • 期刊论文

  • 发表日期：

    2025年10月3日

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  • Emanuele Tommasino,
  • François Ducray,
  • Antoine Seyve,
  • Thiebaud Picard,
  • Anna Martin,
  • Delphine Gamondes,
  • Emilien Jupin Delevaux,
  • Marc Hermier,
  • Yves Berthezene,
  • Alexandre Bani-Sadr

摘要

Objective

To evaluate the diagnostic accuracy of CMRO2 (cerebral metabolic rate of oxygen) in differentiating between pseudoprogression and true tumour progression in patients with glioblastoma (GB) following chemoradiotherapy and to compare its performance with rCBV (relative cerebral blood volume).

Materials and methods

This diagnostic accuracy study included two cohorts: an analysis group (32 patients, 19 progression, 13 pseudoprogression) and a validation group (52 patients, 35 progression, 17 pseudoprogression). Patients underwent MRI (magnetic resonance imaging) with DSC (dynamic susceptibility contrast) and DCE (dynamic contrast-enhanced) perfusion imaging. CMRO2 and rCBV thresholds were evaluated to calculate sensitivity, specificity, and area under the curve (AUC). Inclusion criteria were GB diagnosis, standard chemoradiotherapy, and new or enlarged enhancing lesions on MRI within one year.

Results

In the analysis group (mean age, 60.8 ± 8 years), CMRO2 showed superior performance with an AUC of 0.89 (95% CI 0.77–0.98), sensitivity of 84.2%, and specificity of 83.3%. rCBV achieved an AUC of 0.63 (95% CI 0.42–0.88). In the validation group (mean age, 63 ± 7 years), CMRO2 maintained an AUC of 0.91 (95% CI 0.82–0.98), while rCBV reached an AUC of 0.79 (95% CI 0.65–0.91). The DeLong test confirmed CMRO2's significantly higher performance (p = 0.04).

Conclusion

CMRO2 demonstrates higher diagnostic performance than rCBV in distinguishing pseudoprogression from true progression in GB patients. Despite limitations, CMRO2 shows promise as a non-invasive biomarker, warranting further multicentre validation.