Evaluation of MR markers that predict survival in patients with newly diagnosed GBM prior to adjuvant therapy

Abstract

Purpose Glioblastoma Multiforme (GBM) is the most common and lethal primary brain tumor in adults. The goal of this study was to test the predictive value of MR parameters in relation to the survival of patients with newly diagnosed GBM who were scanned prior to receiving adjuvant radiation and chemotherapy. Methods The study population comprised 68 patients who had surgical resection and were to be treated with fractionated external beam radiation therapy and chemotherapy. Imaging scans included anatomical MRI, diffusion and perfusion weighted imaging and 1H MRSI. The MR data were acquired 3–5 weeks after surgery and approximately 1 week before treatment with radiation therapy. The diffusion, perfusion and spectroscopic parameter values were quantified and subjected to proportional hazards analysis that was adjusted for age and scanner field strength. Results The patients with larger lesion burden based upon volumes of anatomic lesions, volume of CNI2 (number of voxels within the T2 lesion having choline to NAA index >2), volume of CBV3 (number of pixels within the T2 lesion having relative cerebral blood volume >3), and volume of nADC1.5 (number of pixels within the T2 lesion having normalized apparent diffusion coefficient <1.5) had a higher risk for poor outcome. High intensities of combined measures of lactate and lipid in the T2 and CNI2 regions were also associated with poor survival. Conclusions Our study indicated that several pre-treatment anatomic, physiological and metabolic MR parameters are predictive of survival. This information may be important for stratifying patients to specific treatment protocols and for planning focal therapy.

Repeatability of edited lactate and other metabolites in astrocytoma at 3T

“…Cho, which is often taken as a tumor marker, was not significantly different from normal brain. Although brain tumors are characterized by elevated Cho/Cre ratios, this appears to be driven mainly by reductions in Cre, because studies quantifying Cho either absolutely or relative to water tend to find no group differences between tumors and normal white matter (32)(33)(34). Cho reduction in tumors is common when the spectroscopic voxel does not wholly exclude necrotic tissue (which contributes high lipid and lactate signal but little Cho).…”

Magnetic Resonance Spectroscopy — Revisiting the Imaging Aspects of Brain Tumors

“…MRS can easily predict survival rate both in adult and infant brain tumors. Recently a series of work has demonstrated this fact [15][16][17][18] . The ability of MRS to predict survival has been evaluated in both adult and pediatric brain tumor populations.…”

“…The ability of MRS to predict survival has been evaluated in both adult and pediatric brain tumor populations. To this end, a series of papers have recently been evaluated the role of 1 H MRSI in prediction of survival of GBM patients [15][16][17] .…”

A Prognostic Model Based on Preoperative MRI Predicts Overall Survival in Patients with Diffuse Gliomas

“…On the other hand, Zacharaki et al 5 performed a survival analysis of patients with high-grade gliomas based on mean rCBV and ADC values. For the MR imaging analysis, the threshold values selected in our study were median rCBV and ADC, similar to those used by Saraswathy et al, 22 for assessing MR imaging markers that predict survival in patients with glioblastoma before adjuvant therapy.…”