{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T19:07:46Z","timestamp":1779304066753,"version":"3.51.4"},"reference-count":5,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pseudoprogression (PP) is a diagnostic dilemma in the follow\u2010up of brain high grade gliomas (HGG), and the introduction of new therapies has further complicated its identification in Magnetic Resonance Imaging (MRI). We report a case of pseudoprogression after intraoperative radiotherapy (ioRT) and Regorafenib therapy in a patient with anaplastic astrocytoma recurrence. A 65\u2010year\u2010old man, treated in August 2017 for a right frontal anaplastic astrocytoma, with surgical resection and following radiotherapy and Temozolomide, in October 2019 was again treated for peri\u2010surgical bed recurrence with resection and ioRT followed by Regorafenib therapy, interrupted in February 2020, after the onset of adverse reactions. MRI examination showed a large irregular alteration posterior to the surgical bed, T2 weighted hypointense featuring strong diffusion restriction (low ADC values), with an irregular contrast\u2010enhancement (CE) pattern, and surrounded by a vast vasogenic oedema; Dynamic Susceptibility Contrast (DSC) perfusion imaging (PWI) showed no increase of relative cerebral blood volume (rCBV). Particularly, lesion appeared markedly hypointense and dusty\u2010like on susceptibility weighted images (SWI) probably due to a constant hemorrhagic diapedesis promoted by Regorafenib. Therefore, pseudoprogression was suspected. Follow\u2010up MRI exams showed gradual reduction of SWI and CE abnormalities, but a persistent DWI restriction. Unfortunately, the last MRI control showed a secondary cerebellar localisation of the disease. New therapies are changing MRI pattern in HGG imaging and this case underlines how a multimodality approach is increasingly necessary. In particular, when using anti\u2010VEGF drugs, SWI can have a crucial role in identifying therapy\u2010related haemorrhagic changes.<\/jats:p>","DOI":"10.1111\/1754-9485.13267","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T05:20:00Z","timestamp":1624598400000},"page":"414-418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Modification of MRI pattern of high\u2010grade glioma pseudoprogression in regorafenib therapy"],"prefix":"10.1111","volume":"66","author":[{"given":"Mariam","family":"Mansour","sequence":"first","affiliation":[{"name":"Neuroradiology Unit San Bortolo Hospital, AULSS 8 Berica  Vicenza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8042-3959","authenticated-orcid":false,"given":"Valerio","family":"Vitale","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit San Bortolo Hospital, AULSS 8 Berica  Vicenza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Oncology, Oncology 1 Veneto Institute of Oncology IOV\u2010IRCCS  Padova Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Riva","sequence":"additional","affiliation":[{"name":"Pathology Unit San Bortolo Hospital, AULSS 8 Berica  Vicenza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Pancheri","sequence":"additional","affiliation":[{"name":"Oncology Unit San Bortolo Hospital, AULSS 8 Berica  Vicenza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariano","family":"Zanusso","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit San Bortolo Hospital, AULSS 8 Berica  Vicenza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.26171"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6358"},{"key":"e_1_2_5_4_1","first-page":"1037","article-title":"Regorafenib in patients with recurrent high\u2010grade astrocytoma","volume":"145","author":"Kebir S","year":"2019","journal-title":"Res Clin Oncol"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8122031"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3053"}],"container-title":["Journal of Medical Imaging and Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.13267","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1754-9485.13267","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.13267","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T06:31:12Z","timestamp":1692685872000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1754-9485.13267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,24]]},"references-count":5,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1111\/1754-9485.13267"],"URL":"https:\/\/doi.org\/10.1111\/1754-9485.13267","archive":["Portico"],"relation":{},"ISSN":["1754-9477","1754-9485"],"issn-type":[{"value":"1754-9477","type":"print"},{"value":"1754-9485","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,24]]},"assertion":[{"value":"2020-10-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}