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Purpose <p>This study aimed to evaluate and compare the diagnostic performance of quantitative susceptibility mapping (QSM), 3D pseudo-continuous arterial spin labeling (3D-pCASL), and diffusion-weighted imaging (DWI) in differentiating true progression (TP) from pseudoprogression (PsP) in postoperative high-grade glioma (HGG) patients.</p> Methods <p>Forty-nine postoperative HGG patients with newly enhanced lesions were enrolled. All participants underwent conventional MRI, QSM, 3D-pCASL, and DWI. Final diagnoses were confirmed by 6-month longitudinal MRI follow-up or histopathology from reoperation. Quantitative parameters—including the hemorrhagic foci area proportion (proQSM), magnetic susceptibility (SUS), relative maximum cerebral blood flow (rCBF<sub>max</sub>), and relative minimum apparent diffusion coefficient (rADC<sub>min</sub>)—were compared between TP and PsP groups using independent samples t-tests. Diagnostic efficacy was assessed via receiver operating characteristic (ROC) curve analysis, and interparametric correlations were evaluated.</p> Results <p>TP lesions exhibited significantly lower proQSM (<i>p</i> &lt; 0.001) and higher rCBF<sub>max</sub> (<i>p</i> &lt; 0.001) than PsP, with area under the curve (AUC) values of 0.891 and 0.881, respectively. While rADC<sub>min</sub> was marginally reduced in TP (<i>p</i> &lt; 0.05), SUS showed no intergroup difference (<i>p</i> = 0.164). Combining proQSM with rCBF<sub>max</sub> significantly improved diagnostic accuracy (AUC = 0.948). Furthermore, proQSM, rADC<sub>min</sub> showed a negative correlation with rCBF<sub>max</sub>, respectively. (<i>p</i> &lt; 0.0001).</p> Conclusion <p>proQSM and rCBF<sub>max</sub> serve as complementary biomarkers for TP and PsP differentiation. The integration of QSM and ASL imaging significantly improves diagnostic accuracy compared to conventional parameters, providing a noninvasive strategy for postoperative HGG surveillance.</p>

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Combining quantitative susceptibility mapping, arterial spin labeling and diffusion weighted imaging for distinguishing true progression from pseudoprogression in high-grade gliomas

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Yanzhao Diao,
  • Hexin Liang,
  • Feng Lei,
  • Wenjing Li,
  • Sulian Su,
  • Guihua Jiang

摘要

Purpose

This study aimed to evaluate and compare the diagnostic performance of quantitative susceptibility mapping (QSM), 3D pseudo-continuous arterial spin labeling (3D-pCASL), and diffusion-weighted imaging (DWI) in differentiating true progression (TP) from pseudoprogression (PsP) in postoperative high-grade glioma (HGG) patients.

Methods

Forty-nine postoperative HGG patients with newly enhanced lesions were enrolled. All participants underwent conventional MRI, QSM, 3D-pCASL, and DWI. Final diagnoses were confirmed by 6-month longitudinal MRI follow-up or histopathology from reoperation. Quantitative parameters—including the hemorrhagic foci area proportion (proQSM), magnetic susceptibility (SUS), relative maximum cerebral blood flow (rCBFmax), and relative minimum apparent diffusion coefficient (rADCmin)—were compared between TP and PsP groups using independent samples t-tests. Diagnostic efficacy was assessed via receiver operating characteristic (ROC) curve analysis, and interparametric correlations were evaluated.

Results

TP lesions exhibited significantly lower proQSM (p < 0.001) and higher rCBFmax (p < 0.001) than PsP, with area under the curve (AUC) values of 0.891 and 0.881, respectively. While rADCmin was marginally reduced in TP (p < 0.05), SUS showed no intergroup difference (p = 0.164). Combining proQSM with rCBFmax significantly improved diagnostic accuracy (AUC = 0.948). Furthermore, proQSM, rADCmin showed a negative correlation with rCBFmax, respectively. (p < 0.0001).

Conclusion

proQSM and rCBFmax serve as complementary biomarkers for TP and PsP differentiation. The integration of QSM and ASL imaging significantly improves diagnostic accuracy compared to conventional parameters, providing a noninvasive strategy for postoperative HGG surveillance.