Josep Puig1, Gerard Blasco2, Josep Daunis-I-Estadella3, Angel Alberich-Bayarri4, Marco Essig5, Rajan Jain6, Sebastián Remollo2, David Hernández2, Montserrat Puigdemont7, Javier Sánchez-González8, Gloria Mateu3, Max Wintermark9, Salvador Pedraza2. 1. Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain. jpuigalcantara@idibgi.org. 2. Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain. 3. Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain. 4. Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, La Fe Polytechnics and University Hospital, Valencia, Spain. 5. Department of Radiology, University of Manitoba, Winnipeg, Canada. 6. Division of Neuroradiology, Department of Radiology, NYU School of Medicine, New York, NY, USA. 7. Catalan Institute of Oncology (ICO), Hospital Cancer Registry, Hospital Universitari Dr Josep Trueta, Girona, Spain. 8. Philips Healthcare Ibérica, Madrid, Spain. 9. Department of Radiology, Neuroradiology Division, Stanford University, Palo Alto, CA, USA.
Abstract
INTRODUCTION: The objective of the study was to determine whether tumor-associated neovascularization on high-resolution gadofosveset-enhanced magnetic resonance angiography (MRA) is a useful biomarker for predicting survival in patients with newly diagnosed glioblastomas. METHODS: Before treatment, 35 patients (25 men; mean age, 64 ± 14 years) with glioblastoma underwent MRI including first-pass dynamic susceptibility contrast (DSC) perfusion and post-contrast T1WI sequences with gadobutrol (0.1 mmol/kg) and, 48 h later, high-resolution MRA with gadofosveset (0.03 mmol/kg). Volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter were obtained, and DSC perfusion and DWI parameters were evaluated. Prognostic factors were assessed by Kaplan-Meier survival and Cox proportional hazards model. RESULTS: Eighteen (51.42 %) glioblastomas were hypervascular on high-resolution MRA. Hypervascular glioblastomas were associated with higher CEL volume and lower Karnofsky score. Median survival rates for patients with hypovascular and hypervascular glioblastomas treated with surgery, radiotherapy, and chemotherapy were 15 and 9.75 months, respectively (P < 0.001). Tumor-associated neovascularization was the best predictor of survival at 5.25 months (AUC = 0.794, 81.2 % sensitivity, 77.8 % specificity, 76.5 % positive predictive value, 82.4 % negative predictive value) and yielded the highest hazard ratio (P < 0.001). CONCLUSIONS: Tumor-associated neovascularization detected on high-resolution blood-pool-contrast-enhanced MRA of newly diagnosed glioblastoma seems to be a useful biomarker that correlates with worse survival.
INTRODUCTION: The objective of the study was to determine whether tumor-associated neovascularization on high-resolution gadofosveset-enhanced magnetic resonance angiography (MRA) is a useful biomarker for predicting survival in patients with newly diagnosed glioblastomas. METHODS: Before treatment, 35 patients (25 men; mean age, 64 ± 14 years) with glioblastoma underwent MRI including first-pass dynamic susceptibility contrast (DSC) perfusion and post-contrast T1WI sequences with gadobutrol (0.1 mmol/kg) and, 48 h later, high-resolution MRA with gadofosveset (0.03 mmol/kg). Volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter were obtained, and DSC perfusion and DWI parameters were evaluated. Prognostic factors were assessed by Kaplan-Meier survival and Cox proportional hazards model. RESULTS: Eighteen (51.42 %) glioblastomas were hypervascular on high-resolution MRA. Hypervascular glioblastomas were associated with higher CEL volume and lower Karnofsky score. Median survival rates for patients with hypovascular and hypervascular glioblastomas treated with surgery, radiotherapy, and chemotherapy were 15 and 9.75 months, respectively (P < 0.001). Tumor-associated neovascularization was the best predictor of survival at 5.25 months (AUC = 0.794, 81.2 % sensitivity, 77.8 % specificity, 76.5 % positive predictive value, 82.4 % negative predictive value) and yielded the highest hazard ratio (P < 0.001). CONCLUSIONS:Tumor-associated neovascularization detected on high-resolution blood-pool-contrast-enhanced MRA of newly diagnosed glioblastoma seems to be a useful biomarker that correlates with worse survival.
Entities:
Keywords:
Angiography; Brain neoplasms; Glioblastoma; Magnetic resonance imaging; Survival
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