Christian Henker1, Marie Cristin Hiepel2, Thomas Kriesen2, Moritz Scherer3, Änne Glass4, Christel Herold-Mende3, Martin Bendszus5, Sönke Langner6, Marc-André Weber6, Björn Schneider7, Andreas Unterberg3, Jürgen Piek2. 1. Department of Neurosurgery, University Medicine of Rostock, Schillingallee 35, 18055, Rostock, Germany. Christian.Henker@med.uni-rostock.de. 2. Department of Neurosurgery, University Medicine of Rostock, Schillingallee 35, 18055, Rostock, Germany. 3. Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany. 4. Institute for Biostatistics and Informatics in Medicine, University Medicine of Rostock, Rostock, Germany. 5. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany. 6. Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medicine of Rostock, Rostock, Germany. 7. Institute for Pathology, University Medicine of Rostock, Rostock, Germany.
Abstract
BACKGROUND: The objective of this study was to evaluate the morphology of glioblastoma on structural pretreatment magnetic resonance imaging (MRI), defining imaging prognostic factors. METHOD: We conducted a retrospective analysis of MR images from 114 patients harboring a primary glioblastoma, derived from two neurosurgical departments. Tumor segmentation was carried out in a semi-automated fashion. Tumor compartments comprised contrast-enhancing volume (CEV+), perifocal hyperintensity on fluid-attenuated inversion recovery (FLAIR) images (FLAIR+) excluding CEV+, and a non-enhancing area within the CEV+ lesion (CEV-). Additionally, two ratios were calculated from these volumes, the edema-tumor ratio (ETR) and necrosis-tumor ratio (NTR). All patients received surgical resection, followed by concomitant radiation and chemotherapy. RESULTS: Tumor segmentation revealed the strongest correlation between the CEV+ volume and the CEV-, presenting intratumoral necrosis (p < 0.001). The relation between the tumor surrounding the FLAIR+ area and the CEV+ volume and the ETR is inversely correlated (p = 0.001). The most important prognostic factor in multivariable analysis was NTR (HR 2.63, p = 0.016). The cut-off value in our cohort for NTR was 0.33, equivalent to a decrease in survival if the necrotic core of the tumor (CEV-) accounts for more than 33% of the tumor mass itself (CEV+). CONCLUSIONS: Our data emphasizes the importance of the necrosis-tumor ratio as a biomarker in glioblastoma imaging, rather than single tumor compartment volumes. NTR can help to identify a subset of tumors with a higher resistance to therapy and a dismal prognosis.
BACKGROUND: The objective of this study was to evaluate the morphology of glioblastoma on structural pretreatment magnetic resonance imaging (MRI), defining imaging prognostic factors. METHOD: We conducted a retrospective analysis of MR images from 114 patients harboring a primary glioblastoma, derived from two neurosurgical departments. Tumor segmentation was carried out in a semi-automated fashion. Tumor compartments comprised contrast-enhancing volume (CEV+), perifocal hyperintensity on fluid-attenuated inversion recovery (FLAIR) images (FLAIR+) excluding CEV+, and a non-enhancing area within the CEV+ lesion (CEV-). Additionally, two ratios were calculated from these volumes, the edema-tumor ratio (ETR) and necrosis-tumor ratio (NTR). All patients received surgical resection, followed by concomitant radiation and chemotherapy. RESULTS:Tumor segmentation revealed the strongest correlation between the CEV+ volume and the CEV-, presenting intratumoral necrosis (p < 0.001). The relation between the tumor surrounding the FLAIR+ area and the CEV+ volume and the ETR is inversely correlated (p = 0.001). The most important prognostic factor in multivariable analysis was NTR (HR 2.63, p = 0.016). The cut-off value in our cohort for NTR was 0.33, equivalent to a decrease in survival if the necrotic core of the tumor (CEV-) accounts for more than 33% of the tumor mass itself (CEV+). CONCLUSIONS: Our data emphasizes the importance of the necrosis-tumor ratio as a biomarker in glioblastoma imaging, rather than single tumor compartment volumes. NTR can help to identify a subset of tumors with a higher resistance to therapy and a dismal prognosis.
Entities:
Keywords:
Glioblastoma; Magnetic resonance imaging; Necrosis; Neuroimaging; Prognosis; Survival
Authors: Johannes Kasper; Nicole Hilbert; Tim Wende; Michael Karl Fehrenbach; Florian Wilhelmy; Katja Jähne; Clara Frydrychowicz; Gordian Hamerla; Jürgen Meixensberger; Felix Arlt Journal: Curr Oncol Date: 2021-04-07 Impact factor: 3.677
Authors: Clara Le Fèvre; Roger Sun; Hélène Cebula; Alicia Thiery; Delphine Antoni; Roland Schott; François Proust; Jean-Marc Constans; Georges Noël Journal: Sci Rep Date: 2022-06-22 Impact factor: 4.996