MRI Parameters and Their Impact on the Survival of Patients with Glioblastoma: Tumor Perfusion Predicts Survival.

MRI Parameters and Their Impact on the Survival of Patients with Glioblastoma: Tumor Perfusion Predicts Survival.

World Neurosurg. 2018 Dec 26;:

Authors: Hou BL, Wen S, Katsevman GA, Liu H, Urhie O, Turner RC, Carpenter J, Bhatia S

Abstract
BACKGROUND: Many prognostic factors influence the overall survival (OS) of patients with glioblastoma. Despite gross total resection and Stupp protocol adherence, many patients have poor survival. Magnetic resonance (MR) perfusion imaging may assist in diagnosis, treatment monitoring, and prognostication.
METHODS: This is a retrospective study of 36 patients with glioblastoma assessing pre-operative MR parameters reflecting tumor cell density and vascularity, as well as patient age, on overall survival.
RESULTS: The area under curve (AUC) based on optimal Receiver Operating Characteristic (ROC) curves for perfusion parameters Normalized Relative Tumor Blood Volume (n_rTBV) and Normalized Relative Tumor Blood Flow (n_rTBF) were 0.92 and 0.89, respectively, and the highest among all imaging parameters and age. OS showed strongly negative correlations with n_rTBV_c (R=-0.70; p<0.001) and n_rTBF (R=-0.67; p< 0.001). The Cox model, which included age and imaging parameters, demonstrated that n_rTBV and n_rTBF were most predictive of OS, with hazard ratios of 5.97 (p=0.0001) and 8.76 (p=0.0001), respectively, compared to 1.63 (p=0.19) for age. Eighteen patients with n_rTBV_c≤2.5 (best cutoff value) had a median OS of 15.1 months (confidence interval (CI): 11.34-21.25), compared to 2.8 months (95% CI: 1.48-4.03; p<0.001) for 18 patients with n_rTBV_c>2.5. Twenty-four patients with n_rTBF≤2.79 had a median OS of 12 months (95% CI: 10.46-17.9), compared to 2.8 months for 12 patients with n_rTBF>2.79 (95% CI: 1.31-4.2; p<0.001).
CONCLUSION: The dominant predictors of OS are normalized perfusion parameters n_rTBV and n_rTBF. Pre-operative perfusion imaging may be used as a surrogate to predict glioblastoma aggressiveness and survival independent of treatment.

PMID: 30593971 [PubMed - as supplied by publisher]

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