Diffusion kurtosis imaging combined with dynamic susceptibility contrast-enhanced MRI in differentiating high-grade glioma recurrence from pseudoprogression

Abstract Objectives To compare the added value of diffusion kurtosis imaging (DKI) with the combination of dynamic susceptibility contrast-enhanced (DSC) MRI in differentiating glioma recurrence from pseudoprogression. Methods Thirty-four patients with high-grade gliomas developing new and/or increasing enhanced lesions within six months after surgery and chemoradiotherapy were retrospectively analyzed. All patients were pathologically confirmed to have recurrent glioma (n = 22) or pseudoprogression (n = 12). The DKI and DSC MRI parameters were calculated based on the enhanced lesions on contrast-enhanced T1WI. ROC analysis was performed on significant variables to determine their diagnostic performance. Multivariate logistic regression was used to determine the best prediction model for discrimination. Results The relative mean kurtosis (rMK), relative axial kurtosis (rKa), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) of glioma recurrence were higher than those of pseudoprogression (all, P Conclusion DKI may be a valuable non-invasive tool in differentiating glioma recurrence from pseudoprogression, and its use in combination with DSC MRI can improve diagnostic performance in assessing treatment response compared with either technique alone.