• Morad Nasseri, Seymur Gahramanov, Joao Prola Netto, Rongwei Fu, Leslie L Muldoon, Csanad Varallyay, Bronwyn E Hamilton, and Edward A Neuwelt.
• Department of Neurology, Oregon Health & Science University, Portland, Oregon (M.N., S.G., J.P.N., L.L.M., C.V., E.A.N.); Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, Oregon (R.F.); Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon (R.F.); Department of Neuroradiology, Oregon Health & Science University, Portland, Oregon (B.E.H.); Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon (E.A.N.); Department of Veterans Affairs Medical Center, Portland, Oregon (E.A.N.); Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington (S.G.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (M.N.).
• Neuro-oncology. 2014 Aug 1; 16 (8): 1146-54.

BackgroundDiagnosis of pseudoprogression in patients with glioblastoma multiforme (GBM) is limited by Response Assessment in Neuro-Oncology (RANO) criteria to 3 months after chemoradiotherapy (CRT). Frequency of pseudoprogression occurring beyond this time limit was determined. Survival comparison was made between pseudoprogression and true progression patients as determined by using perfusion magnetic resonance imaging with ferumoxytol (p-MRI-Fe).MethodsFifty-six patients with GBM who demonstrated conventional findings concerning for progression of disease post CRT were enrolled in institutional review board-approved MRI protocols. Dynamic susceptibility-weighted contrast-enhanced p-MRI-Fe was used to distinguish true progression from pseudoprogression using relative cerebral blood volume (rCBV) values. rCBV of 1.75 was assigned as the cutoff value. Participants were followed up using RANO criteria, and survival data were analyzed.ResultsTwenty-seven participants (48.2%) experienced pseudoprogression. Pseudoprogression occurred later than 3 months post CRT in 8 (29.6%) of these 27 participants (ie, 8 [14.3%] of the 56 patients meeting the inclusion criteria). Overall survival was significantly longer in participants with pseudoprogression (35.2 months) compared with those who never experienced pseudoprogression (14.3 months; P < .001).ConclusionsPseudoprogression presented after 3 months post CRT in a considerable portion of patients with GBM, which raises doubts about the value of the 3-month time limit of the RANO criteria. Accurate rCBV measurement (eg, p-MRI-Fe) is suggested when there are radiographical concerns about progression of disease in GBM patients, regardless of any time limit. Pseudoprogression correlates with significantly better survival outcomes.© The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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