Combined Dynamic Contrast-Enhanced and Dynamic Susceptibility-Contrast MRI in Differentiating Treatment-related Effects from Progression

Motivation: The differential diagnosis of true tumor progression and treatment-related effects using conventional MRI remains challenging in primary or secondary brain tumors after treatment. Goal(s): To investigate whether combined DCE and DSC MRI can improve diagnostic accuracy. Approach: We enrolled patients with treated glioblastoma or brain metastases who showed enlarged enhancing lesion in the treated bed. DCE and DSC sequences were included in their standard brain MRI scans. We calculated key parameters from DCE and DSC images and analyzed the diagnostic accuracy individually and in combination. Results: Ktrans_mean outperformed other imaging biomarkers. A combined Ktrans_mean and rCBV_mean achieved excellent diagnostic accuracy. Impact: Combined DCE and DSC demonstrated excellent diagnostic accuracy in differentiating treatment-related effects and brain tumor progression when an enlarged enhancing lesion was first spotted on MRI. It could allow physicians to early evaluate treatment response and make decisions accordingly.