Evaluating the diagnostic ability of treatment response assessment maps (TRAMs)/contrast clearance analysis (CCA) in predicting the presence of active brain tumors.

Abstract

Introduction: Brain tumors pose significant diagnostic and therapeutic challenges due to their diverse treatment responses and complex imaging characteristics. Traditional MRI techniques often struggle to differentiate between tumor recurrence and post-treatment changes such as pseudoprogression and necrosis, highlighting the need for more accurate diagnostic tools.

Material and methods: This retrospective study conducted at a single tertiary care center and evaluated the diagnostic efficacy of Treatment Response Assessment Maps (TRAMs), also known as Contrast Clearance Analysis (CCA), in distinguishing between tumor recurrence and post-treatment changes in patients who underwent initial treatment for brain tumors. Data from 27 patients were analyzed, including 10 who underwent surgical resection (Group 1) and 17 who had serial images and TRAMs/CCA assessment (Group 2).

Result: In Group 1, TRAMs/CCA demonstrated nine positive results, with 8 cases of tumor recurrence confirmed via biopsy. A biopsy also confirmed one negative result after a discussion with the patient. In Group 2, where patients did not undergo biopsy, TRAMs/CCA results varied but correlated with clinical outcomes, underscoring the potential utility of TRAMs/CCA in guiding treatment decisions. These findings suggest that TRAMs/CCA may have superior diagnostic performance compared to traditional MRI in differentiating between tumors.

Conclusion: TRAMs/CCA represents a promising advancement in the imaging assessment of brain tumor treatment response, offering higher sensitivity than conventional MRI methods. While implementing TRAMs/CCA could potentially improve diagnostic accuracy and optimize therapeutic strategies for patients with brain tumors, the final decision remains highly dependent on patient-centered discussions.