OBJECTIVE: To prospectively determine institutional cut-off values of apparent diffusion coefficients (ADCs) and concentration of tissue metabolites measured by MR spectroscopy (MRS) for early differentiation between glioblastoma (GBM) relapse and treatment-related changes after standard treatment. MATERIALS AND METHODS: Twenty-four GBM patients who received gross total resection and standard adjuvant therapy underwent MRI examination focusing on the enhancing region suspected of tumor recurrence. ADC maps, concentrations of N-acetylaspartate, choline, creatine, lipids, and lactate, and metabolite ratios were determined. Final diagnosis as determined by biopsy or follow-up imaging was correlated to the results of advanced MRI findings. RESULTS: Eighteen (75%) and 6 (25%) patients developed tumor recurrence and pseudoprogression, respectively. Mean time to radiographic progression from the end of chemoradiotherapy was 5.8 ± 5.6 months. Significant differences in ADC and MRS data were observed between those with progression and pseudoprogression. Recurrence was characterized by N-acetylaspartate ≤ 1.5 mM, choline/N-acetylaspartate ≥ 1.4 (sensitivity 100%, specificity 91.7%), N-acetylaspartate/creatine ≤ 0.7, and ADC ≤ 1300 × 10(-6) mm(2)/s (sensitivity 100%, specificity 100%). CONCLUSION: Institutional validation of cut-off values obtained from advanced MRI methods is warranted not only for diagnosis of GBM recurrence, but also as enrollment criteria in salvage clinical trials and for reporting of outcomes of initial treatment.

Department of Diagnostic Imaging Faculty of Medicine Masaryk University 625 00 Brno Czech Republic ; Department of Diagnostic Imaging St Anne's University Hospital Brno 656 91 Brno Czech Republic

Department of Radiation Oncology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic ; Department of Radiation Oncology Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno 656 91 Brno Czech Republic ; Department of Neurosurgery St Anne's University Hospital Brno Faculty of Medicine Masaryk University 625 00 Brno Czech Republic ; Department of Neurosurgery St Anne's University Hospital Brno 656 91 Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno 656 91 Brno Czech Republic ; Department of Radiation Oncology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic ; Department of Radiation Oncology Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

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