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• Clinical Article •
Value of conventional MRI and perfusion weighted imaging in differentiating high-grade gliomas recurrence from pseudoprogression
HE Hairong  SU Chunqiu  JIN Mingtian  XU Muyuan  CAO Yuandong  HONG Xunning 

DOI:10.12015/issn.1674-8034.2026.02.010.


[Abstract] Objective To explore the value of conventional MRI and perfusion weighted imaging (PWI) in differentiating high-grade gliomas (HGGs) recurrence from pseudoprogression (PsP).Materials and Methods One hundred and six patients with pathologically confirmed HGGs were enrolled in this retrospective study. They were divided into 65 cases in the recurrence group and 41 cases in the PsP group according to the secondary surgical pathology or Response Assessment in Neuro-Oncology (RANO). Volume of interest (VOI) were delineated manually on T1-weighted contrast-enhanced imaging (CE-T1WI). MRIcroGL software was used to measure the cerebral blood volume (CBV) and apparent diffusion coefficient (ADC) values in the contrast-enhancing lesions and peritumoral edema regions, as well as the CBV value in the contralateral semioval center. The relative cerebral blood volume (rCBV) was defined as the ratio of CBV in the contrast-enhancing lesions to the mean CBV in the contralateral semioval center. Differences in rCBV and ADC values between recurrence and PsP groups were analyzed using independent t-tests and Mann-Whitney U tests for both contrast-enhancing lesions and peritumoral edema regions. Logistic regression analysis was used to screen independent risk factors, and area under the curve (AUC) was used to assess the efficacy of the model.Results The recurrence group demonstrated a higher median rCBVmax (Z = -5.829, P < 0.05) in contrast-enhancing lesions and a lower median ADCmean in both enhancing lesions (Z = -5.761, P < 0.05) and peritumoral edema (Z = -3.182, P < 0.05) compared to the PsP group. The logistic regression identified rCBV of contrast-enhancing lesion, ADC of contrast-enhancing lesion and ADC of peritumoral edema as independent predictive risk factors [odds ratio (OR) = 1.494, 0.983, 1.009; 95% CI: 1.191 to 1.874, 0.975 to 0.991, 1.003 to 1.015, all P < 0.05] The combination of these three parameters demonstrated enhanced diagnostic efficacy, with AUC of 0.921, sensitivity of 87.7% and specificity of 90.2%.Conclusions The multi-parameter combined model of conventional MRI and PWI can effectively differentiate postoperative recurrence of HGGs from PsP with high diagnostic efficiency, providing a reliable basis for clinical precise treatment strategy formulation and improving patient prognosis.
[Keywords] high-grade gliomas；magnetic resonance imaging；perfusion weighted imaging；pseudoprogression；recurrence；peritumoral edema

HE Hairong1   SU Chunqiu1   JIN Mingtian1   XU Muyuan1   CAO Yuandong2   HONG Xunning1*  

1 Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

2 Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Corresponding author: HONG X N, E-mail: hongxunning@sina.com

Conflicts of interest   None.

Received  2025-08-26
Accepted  2026-01-02
DOI: 10.12015/issn.1674-8034.2026.02.010
DOI:10.12015/issn.1674-8034.2026.02.010.

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