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Pseudoresponse
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Vascular endothelial growth factor (VEGF)
          • Synonyms

            • Treatment effect, Avastin effect
          • Definitions

            • Antiangiogenic agents may substantially reduce contrast enhancement in glioblastoma multiforme (GBM) related to reduced vascular permeability rather than actual tumor response
              • Bevacizumab (Avastin): An anti-VEGF antibody is the main antiangiogenic agent currently used for treatment of recurrent malignant gliomas
              • Cediranib: A VEGF receptor tyrosine kinase inhibitor, has been tested in recent high-grade glioma treatment trials with similar effects

          IMAGING

          • General Features

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Natural History & Prognosis

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            Selected References

                            1. Barajas RF Jr et al: Assessing Biological Response to Bevacizumab Using 18F-Fluoromisonidazole PET/MR Imaging in a Patient with Recurrent Anaplastic Astrocytoma. Case Rep Radiol. 2015:731361, 2015
                            2. Boxerman JL et al: Response Assessment and Magnetic Resonance Imaging Issues for Clinical Trials Involving High-Grade Gliomas. Top Magn Reson Imaging. 24(3):127-36, 2015
                            3. Ellingson BM et al: Diffusion MRI quality control and functional diffusion map results in ACRIN 6677/RTOG 0625: a multicenter, randomized, phase II trial of bevacizumab and chemotherapy in recurrent glioblastoma. Int J Oncol. 46(5):1883-92, 2015
                            4. Hygino da Cruz LC Jr et al: Neuroimaging and genetic influence in treating brain neoplasms. Neuroimaging Clin N Am. 25(1):121-40, 2015
                            5. Stadlbauer A et al: Quantification of serial changes in cerebral blood volume and metabolism in patients with recurrent glioblastoma undergoing antiangiogenic therapy. Eur J Radiol. 84(6):1128-36, 2015
                            6. Telles BA et al: Imaging of the Posttherapeutic Brain. Top Magn Reson Imaging. 24(3):147-54, 2015
                            7. Furuta T et al: Molecular analysis of a recurrent glioblastoma treated with bevacizumab. Brain Tumor Pathol. 31(1):32-9, 2014
                            8. Shim H et al: Use of high-resolution volumetric MR spectroscopic imaging in assessing treatment response of glioblastoma to an HDAC inhibitor. AJR Am J Roentgenol. 203(2):W158-65, 2014
                            9. Kothari PD et al: Longitudinal restriction spectrum imaging is resistant to pseudoresponse in patients with high-grade gliomas treated with bevacizumab. AJNR Am J Neuroradiol. 34(9):1752-7, 2013
                            10. Fatterpekar GM et al: Treatment-related change versus tumor recurrence in high-grade gliomas: a diagnostic conundrum--use of dynamic susceptibility contrast-enhanced (DSC) perfusion MRI. AJR Am J Roentgenol. 198(1):19-26, 2012
                            11. Yamasaki F et al: Advantages of high b-value diffusion-weighted imaging to diagnose pseudo-responses in patients with recurrent glioma after bevacizumab treatment. Eur J Radiol. 81(10):2805-10, 2012
                            12. Gupta A et al: Isolated diffusion restriction precedes the development of enhancing tumor in a subset of patients with glioblastoma. AJNR Am J Neuroradiol. 32(7):1301-6, 2011
                            13. Hygino da Cruz LC Jr et al: Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. AJNR Am J Neuroradiol. 32(11):1978-85, 2011
                            14. Sorensen AG et al: A "vascular normalization index" as potential mechanistic biomarker to predict survival after a single dose of cediranib in recurrent glioblastoma patients. Cancer Res. 69(13):5296-300, 2009
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Top Differential Diagnoses

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Vascular endothelial growth factor (VEGF)
                                    • Synonyms

                                      • Treatment effect, Avastin effect
                                    • Definitions

                                      • Antiangiogenic agents may substantially reduce contrast enhancement in glioblastoma multiforme (GBM) related to reduced vascular permeability rather than actual tumor response
                                        • Bevacizumab (Avastin): An anti-VEGF antibody is the main antiangiogenic agent currently used for treatment of recurrent malignant gliomas
                                        • Cediranib: A VEGF receptor tyrosine kinase inhibitor, has been tested in recent high-grade glioma treatment trials with similar effects

                                    IMAGING

                                    • General Features

                                      • MR Findings

                                        • Imaging Recommendations

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • General Features

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Natural History & Prognosis

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Barajas RF Jr et al: Assessing Biological Response to Bevacizumab Using 18F-Fluoromisonidazole PET/MR Imaging in a Patient with Recurrent Anaplastic Astrocytoma. Case Rep Radiol. 2015:731361, 2015
                                                      2. Boxerman JL et al: Response Assessment and Magnetic Resonance Imaging Issues for Clinical Trials Involving High-Grade Gliomas. Top Magn Reson Imaging. 24(3):127-36, 2015
                                                      3. Ellingson BM et al: Diffusion MRI quality control and functional diffusion map results in ACRIN 6677/RTOG 0625: a multicenter, randomized, phase II trial of bevacizumab and chemotherapy in recurrent glioblastoma. Int J Oncol. 46(5):1883-92, 2015
                                                      4. Hygino da Cruz LC Jr et al: Neuroimaging and genetic influence in treating brain neoplasms. Neuroimaging Clin N Am. 25(1):121-40, 2015
                                                      5. Stadlbauer A et al: Quantification of serial changes in cerebral blood volume and metabolism in patients with recurrent glioblastoma undergoing antiangiogenic therapy. Eur J Radiol. 84(6):1128-36, 2015
                                                      6. Telles BA et al: Imaging of the Posttherapeutic Brain. Top Magn Reson Imaging. 24(3):147-54, 2015
                                                      7. Furuta T et al: Molecular analysis of a recurrent glioblastoma treated with bevacizumab. Brain Tumor Pathol. 31(1):32-9, 2014
                                                      8. Shim H et al: Use of high-resolution volumetric MR spectroscopic imaging in assessing treatment response of glioblastoma to an HDAC inhibitor. AJR Am J Roentgenol. 203(2):W158-65, 2014
                                                      9. Kothari PD et al: Longitudinal restriction spectrum imaging is resistant to pseudoresponse in patients with high-grade gliomas treated with bevacizumab. AJNR Am J Neuroradiol. 34(9):1752-7, 2013
                                                      10. Fatterpekar GM et al: Treatment-related change versus tumor recurrence in high-grade gliomas: a diagnostic conundrum--use of dynamic susceptibility contrast-enhanced (DSC) perfusion MRI. AJR Am J Roentgenol. 198(1):19-26, 2012
                                                      11. Yamasaki F et al: Advantages of high b-value diffusion-weighted imaging to diagnose pseudo-responses in patients with recurrent glioma after bevacizumab treatment. Eur J Radiol. 81(10):2805-10, 2012
                                                      12. Gupta A et al: Isolated diffusion restriction precedes the development of enhancing tumor in a subset of patients with glioblastoma. AJNR Am J Neuroradiol. 32(7):1301-6, 2011
                                                      13. Hygino da Cruz LC Jr et al: Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. AJNR Am J Neuroradiol. 32(11):1978-85, 2011
                                                      14. Sorensen AG et al: A "vascular normalization index" as potential mechanistic biomarker to predict survival after a single dose of cediranib in recurrent glioblastoma patients. Cancer Res. 69(13):5296-300, 2009