Glioblastoma: Vascular Habitats Detected at Preoperative Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging Predict Survival

Juan–Albarracín, Javier; Fuster–Garcia, Elies; Pérez-Girbés, Alexandre; Robles, Fernando Aparici; Alberich-Bayarri, Ángel; Revert-Ventura, Antonio; Martí‐Bonmatí, Luis; García‐Gómez, Juan Miguel

doi:10.1148/radiol.2017170845

Cited by 61 publications

(121 citation statements)

References 41 publications

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“…According to the study of Lemee, this region is of particular interest due the high rate of local recurrence in the peritumoral brain zone. Although DSC k t r a n s has been proven to be the most sensitive and specific predictor of brain infiltration and histological grading, recent studies also showed that DCE MRI parameters in specific areas of GBM related to the IPE are correlated with biomarkers of hypoxia and overall patient survival . This evidence supports the results obtained on the importance of the IPE habitat to the improvement of GBM patients' prognostic estimation.…”

Section: Discussionsupporting

confidence: 70%

“…This methodology delineates multiparametric habitats, so called hemodynamic tissue signatures (HTSs), that share similar MRI perfusion features within the habitat. A high correlation was found between these HTS perfusion based markers and the overall survival (OS) of the patients studied . This correlation might indicate that GBM aggressiveness is associated with a high angiogenic capacity.…”

Section: Introductionmentioning

confidence: 80%

“…A total of 84 patients with suspected GBM were recovered from 2012 to 2016. The MR images from these patients were also used in the study by Abarracín et al The inclusion criteria of the study were (a) GBM with histopathological confirmation, (b) complete preoperative MR study including morphological ( T 1 , T 2 , T 1 c , and FLAIR) and dynamic susceptibility contrast (DSC) MR perfusion series, (c) patients undergoing standard Stupp treatment, (d) partial or total resection, (e) KPS >80, and (f) good quality fitting of the DSC perfusion signals to the monocompartimental model in the lesion (gamma‐variate R 2 goodness of fit >0.95). A total of 60 patients met the inclusion criteria, with an overall mean age of 61.1 years and range [25‐80] years.…”

Section: Methodsmentioning

confidence: 99%

“…The HTS defines four habitats within the GBM with similar vascular properties: the high angiogenic enhancing tumor (HAT) and low angiogenic enhancing tumor (LAT) habitats, and the potentially infiltrated peripheral edema (IPE) and vasogenic peripheral edema (VPE) habitats. The HTS habitats used in this study were obtained following the original fully automatic and unsupervised algorithm proposed by Albarracín et al, which results in the application of the DCA‐SVFMM method inside the ROI of the tumor lesion. The method is available for non‐clinical use at http://www.oncohabitats.upv.es as a free online service.…”

Section: Methodsmentioning

confidence: 99%

“…[15][16][17][18][19][20] These complex studies describing the heterogeneity of GBM at voxel level require the use of automated multiparametric image analysis methods. [21][22][23][24][25] In particular, the study of Juan-Albarracín et al 26 proposed a methodology to describe GBM vascular intrapatient heterogeneity based on a structured unsupervised multiparametric image analysis technology. This methodology delineates multiparametric habitats, so called hemodynamic tissue signatures (HTSs), that share similar MRI perfusion features within the habitat.…”

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confidence: 99%

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Improving the estimation of prognosis for glioblastoma patients by MR based hemodynamic tissue signatures

et al. 2018

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Advanced MRI and molecular markers have been raised as crucial to improve prognostic models for patients having glioblastoma (GBM) lesions. In particular, different MR perfusion based markers describing vascular intrapatient heterogeneity have been correlated with tumor aggressiveness, and represent key information to understand tumor resistance against effective therapies of these neoplasms. Recently, hemodynamic tissue signature (HTS) markers based on MR perfusion images have been demonstrated to be useful for describing the heterogeneity of GBM at the voxel level, as well as demonstrating significant correlations with the patient's overall survival. In this work, we analyze the abilities of these markers to improve the conventional prognostic models based on clinical, morphological, and demographic features. Our results, in both the regression and classification tests, show that inclusion of the HTS markers improves the reliability of prognostic models. The HTS method is fully automatic and it is available for research use at http://www.oncohabitats.upv.es.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Improving the estimation of prognosis for glioblastoma patients by MR based hemodynamic tissue signatures

et al. 2018

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Electrotherapies for Glioblastoma

et al. 2021

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Non-thermal, intermediate frequency (100-500 kHz) electrotherapies present a unique therapeutic strategy to treat malignant neoplasms. Here, pulsed electric fields (PEFs) which induce reversible or irreversible electroporation (IRE) and tumour-treating fields (TTFs) are reviewed highlighting the foundations, advances, and considerations of each method when applied to glioblastoma (GBM). Several biological aspects of GBM that contribute to treatment complexity (heterogeneity, recurrence, resistance, and blood-brain barrier(BBB)) and electrophysiological traits which are suggested to promote glioma progression are described. Particularly, the biological responses at the cellular and molecular level to specific parameters of the electrical stimuli are discussed offering ways to compare these parameters despite the lack of a universally adopted physical description. Reviewing the literature, a disconnect is found between electrotherapy techniques and how they target the biological complexities of GBM that make treatment difficult in the first place. An attempt is made to bridge the interdisciplinary gap by mapping biological characteristics to different methods of electrotherapy, suggesting important future research topics and directions in both understanding and treating GBM. To the authors' knowledge, this is the first paper that attempts an in-tandem assessment of the biological effects of different aspects of intermediate frequency electrotherapy methods, thus offering possible strategies toward GBM treatment.

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Robust association between vascular habitats and patient prognosis in glioblastoma: An international multicenter study

Álvarez‐Torres

Juan–Albarracín

Fuster–Garcia

et al. 2019

Magnetic Resonance Imaging

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Background Glioblastoma (GBM) is the most aggressive primary brain tumor, characterized by a heterogeneous and abnormal vascularity. Subtypes of vascular habitats within the tumor and edema can be distinguished: high angiogenic tumor (HAT), low angiogenic tumor (LAT), infiltrated peripheral edema (IPE), and vasogenic peripheral edema (VPE). Purpose To validate the association between hemodynamic markers from vascular habitats and overall survival (OS) in glioblastoma patients, considering the intercenter variability of acquisition protocols. Study Type Multicenter retrospective study. Population In all, 184 glioblastoma patients from seven European centers participating in the NCT03439332 clinical study. Field Strength/Sequence 1.5T (for 54 patients) or 3.0T (for 130 patients). Pregadolinium and postgadolinium‐based contrast agent‐enhanced T1‐weighted MRI, T2‐ and FLAIR T2‐weighted, and dynamic susceptibility contrast (DSC) T2* perfusion. Assessment We analyzed preoperative MRIs to establish the association between the maximum relative cerebral blood volume (rCBVmax) at each habitat with OS. Moreover, the stratification capabilities of the markers to divide patients into "vascular" groups were tested. The variability in the markers between individual centers was also assessed. Statistical Tests Uniparametric Cox regression; Kaplan–Meier test; Mann–Whitney test. Results The rCBVmax derived from the HAT, LAT, and IPE habitats were significantly associated with patient OS (P < 0.05; hazard ratio [HR]: 1.05, 1.11, 1.28, respectively). Moreover, these markers can stratify patients into "moderate‐" and "high‐vascular" groups (P < 0.05). The Mann–Whitney test did not find significant differences among most of the centers in markers (HAT: P = 0.02–0.685; LAT: P = 0.010–0.769; IPE: P = 0.093–0.939; VPE: P = 0.016–1.000). Data Conclusion The rCBVmax calculated in HAT, LAT, and IPE habitats have been validated as clinically relevant prognostic biomarkers for glioblastoma patients in the pretreatment stage. This study demonstrates the robustness of the hemodynamic tissue signature (HTS) habitats to assess the GBM vascular heterogeneity and their association with patient prognosis independently of intercenter variability. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1478–1486.

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Glioblastoma: Vascular Habitats Detected at Preoperative Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging Predict Survival

Cited by 61 publications

References 41 publications

Improving the estimation of prognosis for glioblastoma patients by MR based hemodynamic tissue signatures

Improving the estimation of prognosis for glioblastoma patients by MR based hemodynamic tissue signatures

Electrotherapies for Glioblastoma

Robust association between vascular habitats and patient prognosis in glioblastoma: An international multicenter study

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