Accurate DCE-MRI Measurement of Glioblastoma using Point-of-care Portable Perfusion Phantom - PROJECT SUMMARY / ABSTRACT
The goal of this R03 study is to conduct a pilot study testing whether the variability in quantitative DCE-
MRI measurement of glioblastoma across different scanners will be significantly reduced when the UAB-invented
perfusion phantom, P4 (Point-of-care Portable Perfusion Phantom), is used for error correction, leading to better
differentiation between pseudo-progression and true-progression. This is an essential step before validating the
utility of P4 in an extended multi-site clinical trial. Pseudo-progression is known to be associated with better
clinical outcomes, thus pseudo-progression mistaken for true-progression may result in discontinuation of an
effective therapy. Pseudo-progression is a local inflammatory reaction caused by irradiation and enhanced by
concurrent chemotherapy, which leads to transient increase of blood brain barrier (BBB) permeability. The BBB,
however, is also disrupted by neoplasm, thus both pseudo- and true-progressions appear with increased contrast
enhancement in MRI, and there are no established techniques to differentiate between them. The contrast-
enhancing lesions of pseudo-progression are due to inflammatory BBB disruption, whereas those of true-
progression are caused by neoplastic BBB disruption. Thus, true-progression typically presents higher perfusion
than pseudo-progression does. DCE-MRI has the potential to differentiate between pseudo- and true-
progressions of glioblastoma, as it can assess the blood perfusion with minimal susceptibility artifacts, but the
measurement variability remains a major concern. The P4 is small enough to be imaged concurrently in the
bore of a standard MRI scanner with a patient, serving as an internal reference to measure and compensate the
scanner-dependent variation in quantitating perfusion parameters. The P4 successfully reduces the variability
in DCE-MRI measurement of various human tissues in our previous studies. We now hypothesize that the
variability in quantitative DCE-MRI measurement of glioblastoma across different scanners will also be
significantly reduced when MRI system-driven error is corrected using the P4. In this study, a total of 12 patients
with a newly (or enlarged) enhancing glioblastoma after adjuvant chemoradiation therapy will be recruited. Each
patient will be imaged with two different 3T MRI scanners within a 3-day period, and the two DCE-MRI
measurements will be compared to determine the data reproducibility before and after P4-based error correction
and to validate the utility of the P4 for accurate quantitative DCE-MRI measurement of glioblastoma. Also it will
be examined whether the differentiation between pseudo- and true-progressions of glioblastoma can be
improved in quantitative DCE-MRI measurement when the P4 is used for error correction.
