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Abstract #2308

Differentiating glioma recurrence and pseudoprogression by APTw CEST MRI

Kianush Karimian-Jazi1,2, Noah Enbergs1, Evgeny Golubtsov1, Katharina Schregel1, Johannes Benedikt Ungermann1, Hannah Fels-Palesandro1, Daniel Schwarz1, Volker Sturm1, Julius M Kernbach1, David Batra3, Franziska Maria Ippen3,4, Irada Pflüger1, Nikolaus von Knebel Doeberitz5, Sabine Heiland1, Michael Platten6,7, Frank Winkler3,8, Wolfgang Wick3,8, Daniel Paech9, Martin Bendszus1, and Michael Oliver Breckwoldt1,6
1Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany, 2German Cancer Research Center, Heidelberg, Germany, 3Neurology, University Hospital Heidelberg, Heidelberg, Germany, 4German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany, 5Division of Radiology, German Cancer Research Center, Heidelberg, Germany, 6Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center, Heidelberg, Germany, 7Department of Neurology, Medical Faculty Mannheim, Mannheim, Germany, 8Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany, 9Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States

Synopsis

Keywords: CEST / APT / NOE, CEST & MT, Glioma

Motivation: Recurrent gliomas are treatment-resistant due to metabolic and molecular heterogeneity, posing challenges for accurate monitoring with conventional MRI.

Goal(s): This study aims to evaluate Amide Proton Transfer weighted (APTw) CEST MRI as an imaging biomarker to better assess glioma heterogeneity and differentiate progression from pseudoprogression (PsPD).

Approach: A prospective, single-center trial of 371 glioma patients identified 30 with recurrence and 12 with PsPD. Standard MRI sequences and APTw imaging were performed, with semi-automated segmentation and quantitative analysis.

Results: APTw values distinguished progressive disease from PsPD, revealed metabolic hotspots, and detected resection cavity changes at recurrence, underscoring APTw’s clinical utility in neuro-oncological monitoring.

Impact: This study highlights APTw-CEST MRI's value as an imaging biomarker, aiding clinicians in differentiating progression from pseudoprogression. It enables targeted treatment strategies and opens new research into metabolic imaging for personalized glioma management, enhancing patient care and guiding therapy decisions.

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