Adding DSC PWI and DWI to BT-RADS can help identify postoperative recurrence in patients with high-grade gliomas

Background The Brain Tumor Reporting and Data System (BT-RADS) category 3 is suitable for identifying cases with intermediate probability of tumor recurrence that do not meet the Response Assessment in Neuro-Oncology (RANO) criteria for progression. The aim of this study was to evaluate the added value of dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC PWI) and diffusion-weighted imaging (DWI) to BT-RADS for differentiating tumor recurrence from non-recurrence in postoperative high-grade glioma (HGG) patients with category 3 lesions. Methods Patients with BT-RADS category 3 lesions were included. The maximal relative cerebral blood volume (rCBV(max)) and the mean apparent diffusion coefficient (ADC(mean)) values were measured. The added value of DSC PWI and DWI to BT-RADS was evaluated by receiver operating characteristic (ROC) curve analysis. Results Fifty-one of 91 patients had tumor recurrence, and 40 patients did not. There were significant differences in rCBV(max) and ADC(mean) between the tumor recurrence group and non-recurrence group. Compared to BT-RADS alone, the addition of DSC PWI to BT-RADS increased the area under curve (AUC) from 0.76 (95% confidence interval [CI] 0.66-0.84) to 0.90 (95% CI 0.81-0.95) for differentiating tumor recurrence from non-recurrence. The addition of DWI to BT-RADS increased the AUC from 0.76 (95% CI 0.66-0.84) to 0.88 (95% CI 0.80-0.94). The combination of BT-RADS, DSC PWI, and DWI exhibited the best diagnostic performance (AUC = 0.95; 95% CI 0.88-0.98) for differentiating tumor recurrence from non-recurrence. Conclusion Adding DSC PWI and DWI to BT-RADS can significantly improve the diagnostic performance for differentiating tumor recurrence from non-recurrence in BT-RADS category 3 lesions.