{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:18:23Z","timestamp":1785907103739,"version":"3.56.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:00:00Z","timestamp":1740182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"UVM Cancer Center","award":["040311"],"award-info":[{"award-number":["040311"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with IDH-mutant low-grade glioma (LGG) can achieve many years of survival with radiation (RT) and chemotherapy. There is a risk of overtreatment and negative treatment side effects if these patients are unnecessarily retreated due to perceived tumor progression in the absence of true tumor regrowth. A better understanding of volumetric postradiation FLAIR changes will help with the clinical interpretation of disease progression\/treatment effect and will help guide management decisions. We conducted this research to characterize the changes in MRI FLAIR hyperintensity that occur in LGG patients following RT, to better understand the radiation-treatment effects or \u201cpseudoprogression\u201d that occurs in the absence of true tumor regrowth.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Serial MRI scans of patients with LGG were reviewed, including pre-RT and for 2.5 years post-RT. Segmentation for volumetric analysis was performed with manual supervision using ITK-SNAP (open-source segmentation software). Descriptive statistics are reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Sixteen patients with histologic grade 2 gliomas were included. 159 MRI scans were segmented using ITK-SNAP (median 9.5 MRIs\/patient). Nine of 16 MRIs showed decreasing FLAIR volume immediately post-RT, while 7\/16 showed increasing FLAIR volume. After the initial post-RT MRI, 12\/16 patients had MRIs with an increase in FLAIR volume sometime during the first year. The FLAIR volume stabilized or decreased a median of 18.4 months and a mean of 15.0 months post-RT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>FLAIR hyperintensity changes on MRI are highly variable in the first 1.5 years post-RT in low-grade glioma, but after 1.5 years, FLAIR volumes stabilize and decrease, likely indicating the inflection point where post-RT pseudoprogression stabilizes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/nop\/npaf024","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T23:21:33Z","timestamp":1740007293000},"page":"631-636","source":"Crossref","is-referenced-by-count":1,"title":["A volumetric analysis of timing and duration of T2\/FLAIR changes on MRI following radiation therapy in patients with low-grade IDH-mutant glioma"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2498-1563","authenticated-orcid":false,"given":"Isabella","family":"Sutherland","sequence":"first","affiliation":[{"name":"Larner College of Medicine, University of Vermont , Burlington, VT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Ulano","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Vermont Medical Center , Burlington, VT ,","place":["USA"]},{"name":"Larner College of Medicine, University of Vermont , Burlington, VT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa A","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, University of Vermont Medical Center , Burlington, VT ,","place":["USA"]},{"name":"Larner College of Medicine, University of Vermont , Burlington, VT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"issue":"3","key":"2025081316520884300_CIT0001","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1093\/neuonc\/noaa168","article-title":"CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p\/19q codeleted oligodendroglioma. Analysis from the initial study design","volume":"23","author":"Jaeckle","year":"2021","journal-title":"Neuro-Oncology."},{"issue":"12","key":"2025081316520884300_CIT0002","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1158\/1078-0432.CCR-21-4283","article-title":"Temozolomide and radiotherapy versus radiotherapy alone in patients with glioblastoma, IDH-wildtype: post hoc analysis of the EORTC randomized phase III CATNON trial","volume":"28","author":"Tesileanu","year":"2022","journal-title":"Clin Cancer Res."},{"issue":"4","key":"2025081316520884300_CIT0003","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00234-020-02621-7","article-title":"Intracranial long-term complications of radiation therapy: an image-based review","volume":"63","author":"Carr","year":"2021","journal-title":"Neuroradiology."},{"issue":"1","key":"2025081316520884300_CIT0004","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2214\/ajr.149.1.165","article-title":"Radiation effects on cerebral white matter: MR evaluation","volume":"149","author":"Tsuruda","year":"1987","journal-title":"Am J Roentgenol"},{"issue":"7","key":"2025081316520884300_CIT0005","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2217\/fon.13.271","article-title":"Postradiation imaging changes in the CNS: how can we differentiate between treatment effect and disease progression","volume":"10","author":"Walker","year":"2014","journal-title":"Future Oncol."},{"issue":"8","key":"2025081316520884300_CIT0006","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s11912-014-0397-x","article-title":"Post-treatment imaging changes in primary brain tumors","volume":"16","author":"O\u2019Brien","year":"2014","journal-title":"Curr Oncol Rep."},{"issue":"4","key":"2025081316520884300_CIT0007","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1586\/ern.13.7","article-title":"Pseudoprogression after glioma therapy: a comprehensive review","volume":"13","author":"Kruser","year":"2013","journal-title":"Expert Rev Neurother."},{"issue":"1","key":"2025081316520884300_CIT0008","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/neuonc\/noac207","article-title":"Isocitrate dehydrogenase (IDH) mutant gliomas: a society for neuro-oncology (SNO) consensus review on diagnosis, management, and future directions","volume":"25","author":"Miller","year":"2023","journal-title":"Neuro Oncol"},{"issue":"5","key":"2025081316520884300_CIT0009","first-page":"719","article-title":"Incidence of pseudoprogression in low-grade gliomas treated with radiotherapy","volume":"19","author":"van West","year":"2017","journal-title":"Neuro Oncol"},{"key":"2025081316520884300_CIT0010","first-page":"405","article-title":"Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide","volume-title":"Cancer","author":"Taal","year":"2008"},{"issue":"5","key":"2025081316520884300_CIT0011","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/neuonc\/nos307","article-title":"Differentiating tumor recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies","volume":"15","author":"Verma","year":"2013","journal-title":"Neuro Oncol"},{"issue":"1","key":"2025081316520884300_CIT0012","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1093\/neuonc\/not142","article-title":"Codeletions at 1p and 19q predict a lower risk of pseudoprogression in oligodendrogliomas and mixed oligoastrocytomas","volume":"16","author":"Lin","year":"2014","journal-title":"Neuro Oncol"},{"issue":"11","key":"2025081316520884300_CIT0013","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1200\/JCO.2009.26.3541","article-title":"Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group","volume":"28","author":"Wen","year":"2010","journal-title":"J Clin Oncol."},{"key":"2025081316520884300_CIT0014","doi-asserted-by":"crossref","first-page":"109674","DOI":"10.1016\/j.radonc.2023.109674","article-title":"(2023) Early and late contrast enhancing lesions after photon radiotherapy for IDH mutated grade 2 diffuse glioma","volume":"184","author":"Jaspers","year":"2023","journal-title":"Radiother Oncol."},{"issue":"3","key":"2025081316520884300_CIT0015","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s11060-017-2375-2","article-title":"Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape","volume":"134","author":"Ellingson","year":"2017","journal-title":"J Neurooncol."},{"issue":"1","key":"2025081316520884300_CIT0016","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/pbc.25179","article-title":"Pseudoprogression of low-grade gliomas after radiotherapy","volume":"62","author":"Naftel","year":"2015","journal-title":"Pediatr Blood Cancer."},{"issue":"5","key":"2025081316520884300_CIT0017","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.ijrobp.2021.12.007","article-title":"Pseudoprogression is frequent after front-line radiation therapy in pediatric low-grade glioma: results from the German low-grade glioma cohort","volume":"112","author":"Stock","year":"2022","journal-title":"Int J Radiat Oncol Biol Phys."},{"key":"2025081316520884300_CIT0018","first-page":"30","article-title":"Analysis of pseudoprogression after proton or photon therapy of 99 patients with low grade and anaplastic glioma","volume":"9","author":"Bronk","year":"2018","journal-title":"Clin Transl Radiat Oncol"},{"issue":"3","key":"2025081316520884300_CIT0019","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s11060-021-03734-6","article-title":"Distinct imaging patterns of pseudoprogression in glioma patients following proton versus photon radiation therapy","volume":"152","author":"Ritterbusch","year":"2021","journal-title":"J Neurooncol."},{"issue":"1","key":"2025081316520884300_CIT0020","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s11060-018-03063-1","article-title":"Increase of pseudoprogression and other treatment related effects in low-grade glioma patients treated with proton radiation and temozolomide","volume":"142","author":"Dworkin","year":"2019","journal-title":"J Neurooncol."}],"container-title":["Neuro-Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/nop\/advance-article-pdf\/doi\/10.1093\/nop\/npaf024\/62049963\/npaf024.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/nop\/article-pdf\/12\/4\/631\/62049963\/npaf024.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/nop\/article-pdf\/12\/4\/631\/62049963\/npaf024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T20:52:15Z","timestamp":1755118335000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/nop\/article\/12\/4\/631\/8029983"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,22]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2,22]]},"published-print":{"date-parts":[[2025,8,13]]}},"URL":"https:\/\/doi.org\/10.1093\/nop\/npaf024","relation":{},"ISSN":["2054-2577","2054-2585"],"issn-type":[{"value":"2054-2577","type":"print"},{"value":"2054-2585","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,2,22]]}}}