Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment With Standard-of-Care

Curtin, Lee; Whitmire, Paula; Rickertsen, Cassandra; Mazza, Gina L.; Canoll, Peter; Johnston, Sandra K.; Mrugala, Maciej M.; Swanson, Kristin R.; Hu, Leland

doi:10.3389/fonc.2020.580750

Cited by 13 publications

(22 citation statements)

References 33 publications

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“…On the other hand, a few investigators have assessed direct or indirect correlations between GBM compartment volume in magnetic resonance imaging (MRI) and prognosis. However, these findings have not been consistent so far [12,13]. The purpose of the present study was to determine possible correlations between the volumetric analysis of glioblastoma compartments and the proliferation index represented by Ki-67.…”

Section: Introductionmentioning

confidence: 83%

Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients?

Caramanti¹,

Aprígio²,

Rocha³

et al. 2022

Cureus

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IntroductionDespite all the progress with genetic mapping and multimodal treatment, the prognosis of Glioblastoma multiforme (GBM) remains poor, with median overall survival (OS) of only 12 to 15 months. Several studies showed correlations between glioblastoma clinic and prognosis factors; however, it doesn`t occur with tumor radiological features. The purpose of this study is to determine possible correlations between the volumetric analysis of glioblastoma compartments and the proliferation index represented by Ki-67. MethodsWe performed a retrospective analysis of MRI studies of 70 patients with glioblastoma multiforme acquired up to one week before surgery. The tumor compartments were divided into enhancing zone; edema zone and tumor total zone. Each compartment was submitted to volumetric analysis using Horos Project software. A linear regression model was used to assess correlations between the ki-67 index and the volume of each compartment with a p-value of 0.05. ResultsThe male/female ratio in our study was 1.7:1, at a mean age of 60.7 ± 14.6 years. Tumor predominant location was the temporal lobe with 25% of cases and cystic morphology was present in 17%. The median of Ki-67 was 40%. The average tumor compartment volume was 40 cm 3 for the contrast-enhancing zone, 62 cm 3 for the edema zone, and 103 cm 3 for the total tumor volume. A significant association between the Ki-67 index and edema zone volume (p=0.02) was found. ConclusionVolumetric analysis of the glioblastoma edema zone by MRI allows for predicting tumor aggressiveness through correlation with the Ki-67 index.

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Section: Introductionmentioning

confidence: 83%

Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients?

Caramanti¹,

Aprígio²,

Rocha³

et al. 2022

Cureus

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“…Pathophysiology of cyst formation in gliomas is still questionable, with most theories establishing a disruption of the blood-brain barrier and hyperproteic effusion. Cystic areas are homogeneous, non-enhancing, and smooth-walled areas, with signal intensity similar to CSF, contrasting with generally central, heterogeneous, and irregular marginated necrosis areas (37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Ki67 Index Correlates with Tumoral Volumetry, and 5-ALA Compromised Resection Margins in Glioblastoma

Sprenger

Silva

Ramina

et al. 2022

Preprint

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Background: Malignant gliomas are the most prevalent primary cerebral tumor. Preoperative imaging plays an important role, and the prognosis is closely related to surgical resection and histomolecular aspects. Our goal was to correlate Ki67 indexes with tumoral volumetry in semiautomatic segmentation on preoperative magnetic resonance images in a 5-ALA assisted resection cohort.Methods: We included initially seventy-eight IDH-wildtype glioblastoma patients with complete preoperative imaging submitted to 5-ALA assisted resections. Clinical, surgical, and histomolecular ndings were also obtained. Preoperative magnetic resonance studies were preprocessed and segmented semiautomatically on VISVA for whole tumor (WT) on 3D FLAIR, enhancing tumor (ET), and necrotic core (NC) on 3D post-gadolinium T1. Edema volumes (ED) were obtained from the subtraction of ET and NC from WT. According to previous studies, we used a 20% cutoff for Ki67 for statistical analysis.Results: Final sample was of 48 patients. Higher Ki-67 indexes correlated positively with higher WT (p = 0,01), ET (p = 0,03) and ED volumes (p = 0,04), with no correlation with NC volumes (p = 0,18). Ki67indexes were also higher in 5-ALA compromised margins (p = 0,01).Conclusions: There is a correlation between Ki67, the metabolically active tumoral volumes, and 5-ALA compromised margins. Tumoral volumetry aspects (WT, ET, and ED), except for NC, correlated directly with Ki67 indexes. Methodological inconsistencies are probably responsible for contradictory literature ndings, and further studies are needed to validate and reproduce these ndings.

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“…We also required that these patients' tumors did not contain a significant cystic component, which typically presents as hypointense with surrounding enhancement and smooth on T2-weighted MRI. Cystic components are typically round and may provide a survival benefit to patients (17), which may have interfered with relationships between morphological metrics and survival. Hypointense cystic fluid would also interfere with our ability to consistently capture necrotic regions, which are also hypointense.…”

Section: Methodsmentioning

confidence: 99%

Morphological Metrics of Magnetic Resonance Imaging of Glioblastoma as Biomarkers of Prognosis

Curtin

Whitmire

White

et al. 2021

Preprint

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Morphological characteristics have been linked to outcomes across a variety of cancers. Lacunarity is a quantitative morphological measure of how shapes fill space while fractal dimension is a morphological measure of the complexity of pixel arrangement. Glioblastoma is the most aggressive primary brain tumor with a short expected survival given the current standard-of-care treatment. Due to the sensitive location of the tumor, there is a heavy reliance on imaging to assess the state of the disease in the clinic. In this project, we computed lacunarity and fractal dimension values for glioblastoma-induced abnormalities on gadolinium-enhanced T1-weighted magnetic resonance imaging (T1Gd MRI) as well as T2-weighted (T2) and fluid-attenuated inversion recovery (FLAIR) MRIs. In our patient cohort (n=402), we aim to connect these morphological metrics calculated on pretreatment MRI with the survival of patients with GBM. We calculated lacunarity and fractal dimension across all MRI slices on necrotic regions (n=390) and abnormalities on T1Gd MRI (n=402), as well as on enhancing abnormalities present on T2/FLAIR MRI (n=257). We also explored the relationship between these metrics and age at diagnosis, as well as abnormality volume. We found statistically significant relationships to outcome across all three imaging subtypes, with the shape of T2/FLAIR abnormalities showing the strongest relationship with overall survival. The link between morphological and survival metrics could be driven by underlying biological phenomena, tumor location or microenvironmental factors that should be further explored.

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Assessment of Prognostic Value of Cystic Features in Glioblastoma Relative to Sex and Treatment With Standard-of-Care

Cited by 13 publications

References 33 publications

Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients?

Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients?

Ki67 Index Correlates with Tumoral Volumetry, and 5-ALA Compromised Resection Margins in Glioblastoma

Morphological Metrics of Magnetic Resonance Imaging of Glioblastoma as Biomarkers of Prognosis

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