Differentiating actual tumour progression from pseudo progression is a real issue that creates a great deal of anxiety for those with a history of a brain tumour. It’s an all too common problem.

In my own circumstances - going back many years now - this confusion wasn’t caused by any kind of treatment I had/didn’t have, but was as a result of the type of neuroinflammation I had sustained. - a brain haemorrhage, several grand mal seizures, and continued vascular damage surrounding the tumour.

The main source of confusion lies in the fact that traditional brain MRI scans can be fairly ambiguous, often making it difficult to distinguish between tumour recurrence and treatment-related changes. In fact, in many cases, several sequential MRI scans are required to determine whether an area of concern represents true tumour progression or a temporary treatment effect (not just from cytotoxic agents), delaying both clarity and potentially important treatment decisions.

The good news is that there may be better methods to remove at least some of the doubt we have by measuring ‘brain stiffness’ with a type of MRI called Magnetic resonance elastography (MRE).

I’ve written about this before in a slightly different context, which can be found on my Substack following the attached link -

It’s an approach that has been validated in several studies now, including this one from last year - sciencedirect.com/scien….

From this type of imaging, in line with the existing evidence, we would expect true tumour progression to clearly show noticeably reduced stiffness compared to normal brain tissue, while the majority of pseudoprogression lesions should show no significant stiffness reduction.

If you want to see what a lack of brain stiffness actually looks like in this context, the attached image shows how an aggressive brain tumour (IDH-mutant glioblastoma) can spread deep into the brain, softening and disrupting normal tissue. The spongey appearance suggests a loss of stiffness, something that Magnetic Resonance Elastography (MRE) can detect even before damage is visible. (researchgate.net/figure…)

Ask your oncologist what they think about this type of MRI and its utility. I would be very interested in hearing their thoughts, or anyone who has expertise in this area.