ObjectiveTo develop and validate a volume-based, quantitative imaging marker by integrating multiparametric MR images for predicting glioblastoma survival, and to investigate its relations and synergy with molecular characteristics.
Materials and MethodsWe retrospectively analyzed 108 patients with primary glioblastoma. The discovery cohort consisted of 62 patients from the cancer genome atlas (TCGA). Another 46 patients combining 30 from TCGA and 16 internally were used for independent validation. Based on integrated analyses of T1-weighted contrast-enhanced (T1-c) and diffusion-weighted MR images, we identified an intratumoral subregion with both high T1-c and low ADC, and accordingly defined a high-risk volume (HRV). We evaluated its prognostic value and biological significance with genomic data.
ResultsOn both discovery and validation cohorts, HRV predicted overall survival (OS) (concordance index: 0.642 and 0.653, P<0.001 and P=0.038, respectively). HRV stratified patients within the proneural molecular subtype (log-rank P=0.040, hazard ratio=2.787). We observed different OS among patients depending on their MGMT methylation status and HRV (logrank P=0.011). Patients with unmethylated MGMT and high HRV had significantly shorter survival (median survival: 9.3 versus 18.4 months, log-rank P=0.002).
ConclusionMain Document (blinded ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 Volume of the high-risk intratumoral subregion identified on multi-parametric MRI predicts glioblastoma survival, and may provide complementary value to genomic information.
KeywordsMulti-parametric MRI, glioblastoma multiforme, high-risk tumor volume, overall survival, radiogenomics Key Points 1. High-risk volume (HRV) defined on multi-parametric MRI predicted GBM survival.2. The proneural molecular subtype tended to harbor smaller HRV than other subtypes.3. Patients with unmethylated MGMT and high HRV had significantly shorter survival.4. HRV complements genomic information in predicting GBM survival 1
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