Prognostic Value of MRS Metabolites in Postoperative Irradiated High Grade Gliomas

Tolia, Maria; Verganelakis, Dimitrios; Tsoukalas, Nikolaos; Kyrgias, George; Papathanasiou, Matilda; Mosa, Eftichia; Kokakis, Ioannis; Kouvaris, John; Pissakas, George; Pistevou-Gombaki, Kyriaki; Kelekis, Nikolaos; Kouloulias, Vasileios

doi:10.1155/2015/341042

Cited by 8 publications

(5 citation statements)

References 26 publications

(28 reference statements)

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“…The present study complements and extends earlier OS predictors based on the WHO classification (2–4) or in vivo MRI/MRS studies (19–21, 33–40), contributing a novel array of metabolomic biomarkers organized hierarchically by a multivariate CRT. Earlier studies implementing in vivo MRS/MRI approaches investigated mainly glioblastoma patients (Table 5), associating Short-OS to increases in PC (4) and tCho/NAA (20, 36–40, 42), and longer OS to higher contents in GPC (35).…”

Section: Discussionsupporting

confidence: 71%

Assessment of Overall Survival in Glioma Patients as Predicted by Metabolomic Criteria

et al. 2019

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Objective: We assess the efficacy of the metabolomic profile from glioma biopsies in providing estimates of postsurgical Overall Survival in glioma patients. Methods: Tumor biopsies from 46 patients bearing gliomas, obtained neurosurgically in the period 1992–1998, were analyzed by high resolution 1 H magnetic resonance spectroscopy (HR- 1 H MRS), following retrospectively individual postsurgical Overall Survival up to 720 weeks. Results: The Overall Survival profile could be resolved in three groups; Short (shorter than 52 weeks, n = 19), Intermediate (between 53 and 364 weeks, n = 19) or Long (longer than 365 weeks, n = 8), respectively. Classical histopathological analysis assigned WHO grades II–IV to every biopsy but notably, some patients with low grade glioma depicted unexpectedly Short Overall Survival, while some patients with high grade glioma, presented unpredictably Long Overall Survival. To explore the reasons underlying these different responses, we analyzed HR- 1 H MRS spectra from acid extracts of the same biopsies, to characterize the metabolite patterns associated to OS predictions. Poor prognosis was found in biopsies with higher contents of alanine, acetate, glutamate, total choline, phosphorylcholine, and glycine, while more favorable prognosis was achieved in biopsies with larger contents of total creatine, glycerol-phosphorylcholine, and myo-inositol. We then implemented a multivariate analysis to identify hierarchically the influence of metabolomic biomarkers on OS predictions, using a Classification Regression Tree (CRT) approach. The CRT based in metabolomic biomarkers grew up to three branches and split into eight nodes, predicting correctly the outcome of 94.7% of the patients in the Short Overall Survival group, 78.9% of the patients in the Intermediate Overall Survival group, and 75% of the patients in the Long Overall Survival group, respectively. Conclusion: Present results indicate that metabolic profiling by HR- 1 H MRS improves the Overall Survival predictions derived exclusively from classical histopathological gradings, thus favoring more precise therapeutic decisions.

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Section: Discussionsupporting

confidence: 71%

Assessment of Overall Survival in Glioma Patients as Predicted by Metabolomic Criteria

et al. 2019

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“…They also reported that Lac/NAA > 2 was a strong independent prognostic risk factor (38). In 2015, Tolia et al explored the prognostic value of MRS metabolites in postoperative irradiated high-grade gliomas and found that Cho/Cr ≥ 2 was associated with earlier recurrence (39). All these results support the hypothesis that substantial tumor cells do exist in PEZ and spectroscopy can provide accurate tumor metabolism information for physicians to better control gliomas.…”

Section: Discussionmentioning

confidence: 92%

Higher Cho/NAA Ratio in Postoperative Peritumoral Edema Zone Is Associated With Earlier Recurrence of Glioblastoma

et al. 2020

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Objective: To explore the prognostic significance of metabolic parameters in postoperative peritumoral edema zone (PEZ) of patients with glioblastoma (GBM) based on proton magnetic resonance spectroscopy (MRS).Methods: The postoperative MRS data of 67 patients with GBM from Beijing Tiantan Hospital were retrospectively reviewed. Metabolite ratios including Cho/NAA, Cho/Cr, and NAA/Cr in both postoperative PEZ and contralateral normal brain region were recorded. Log-rank analysis and Cox regression model were used to identify parameters correlated with progression-free survival (PFS) and overall survival (OS).Results: Compared with the contralateral normal brain region, postoperative PEZ showed a lower ratio of NAA/Cr (1.20 ± 0.42 vs. 1.81 ± 0.48, P < 0.001), and higher ratios of Cho/Cr and Cho/NAA (1.36 ± 0.44 vs. 1.02 ± 0.27, P < 0.001 and 1.32 ± 0.59 vs. 0.57 ± 0.14, P < 0.001). Both the ratios of Cho/NAA and NAA/Cr were identified as prognostic factors in univariate analysis (P < 0.05), while only Cho/NAA ≥ 1.31 was further confirmed as an independent risk factor for early recurrence in the Cox regression model (P < 0.01). According to the factors of MGMT promoter unmethylation, without radiotherapy and Cho/NAA ≥ 1.31, a prognostic scoring scale for GBM was established, which could divide patients into low-risk, moderate-risk, and high-risk groups. There was a significant difference of survival rate between the three groups (P < 0.001).Conclusions: Higher Cho/NAA ratio in the postoperative PEZ of GBM predicts earlier recurrence and is associated with poor prognosis. The prognostic scoring scale based on clinical, molecular and metabolic parameters of patients with GBM can help doctors to make more precise prediction of survival time and to adjust therapeutic regimens.

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“…[ 42 ] In another study, after investigation of the recurrence free survival (RFS) and MRS parameters including NAA/Cr, Cho/Cr, Cho/NAA, and MI/Cr ratios in HGG patients, the authors concluded that the Cho/ Cr ratio has a significant correlation with RFS. [ 97 ]…”

Section: Resultsmentioning

confidence: 99%

Imaging Role in Diagnosis, Prognosis, and Treatment Response Prediction Associated with High-grade Glioma

Heidari,

Shokrani

2024

Journal of Medical Signals &Amp; Sensors

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Background: Glioma is one of the most drug and radiation-resistant tumors. Gliomas suffer from inter- and intratumor heterogeneity which makes the outcome of similar treatment protocols vary from patient to patient. This article is aimed to overview the potential imaging markers for individual diagnosis, prognosis, and treatment response prediction in malignant glioma. Furthermore, the correlation between imaging findings and biological and clinical information of glioma patients is reviewed. Materials and Methods: The search strategy in this study is to select related studies from scientific websites such as PubMed, Scopus, Google Scholar, and Web of Science published until 2022. It comprised a combination of keywords such as Biomarkers, Diagnosis, Prognosis, Imaging techniques, and malignant glioma, according to Medical Subject Headings. Results: Some imaging parameters that are effective in glioma management include: ADC, FA, Ktrans, regional cerebral blood volume (rCBV), cerebral blood flow (CBF), ve, Cho/NAA and lactate/lipid ratios, intratumoral uptake of 18F-FET (for diagnostic application), RD, ADC, ve, vp, Ktrans, CBFT1, rCBV, tumor blood flow, Cho/NAA, lactate/lipid, MI/Cho, uptakes of 18F-FET, 11C-MET, and 18F-FLT (for prognostic and predictive application). Cerebral blood volume and Ktrans are related to molecular markers such as vascular endothelial growth factor (VEGF). Preoperative ADCmin value of GBM tumors is associated with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. 2-hydroxyglutarate metabolite and dynamic 18F-FDOPA positron emission tomography uptake are related to isocitrate dehydrogenase (IDH) mutations. Conclusion: Parameters including ADC, RD, FA, rCBV, Ktrans, vp, and uptake of 18F-FET are useful for diagnosis, prognosis, and treatment response prediction in glioma. A significant correlation between molecular markers such as VEGF, MGMT, and IDH mutations with some diffusion and perfusion imaging parameters has been identified.

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Prognostic Value of MRS Metabolites in Postoperative Irradiated High Grade Gliomas

Cited by 8 publications

References 26 publications

Assessment of Overall Survival in Glioma Patients as Predicted by Metabolomic Criteria

Assessment of Overall Survival in Glioma Patients as Predicted by Metabolomic Criteria

Higher Cho/NAA Ratio in Postoperative Peritumoral Edema Zone Is Associated With Earlier Recurrence of Glioblastoma

Imaging Role in Diagnosis, Prognosis, and Treatment Response Prediction Associated with High-grade Glioma

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