Precise enhancement quantification in post-operative MRI as an indicator of residual tumor impact is associated with survival in patients with glioblastoma

Abstract

Glioblastoma is the most common primary brain tumor. Standard therapy consists of maximum safe resection combined with adjuvant radiochemotherapy followed by chemotherapy with temozolomide, however prognosis is extremely poor. Assessment of the residual tumor after surgery and patient stratification into prognostic groups (i.e., by tumor volume) is currently hindered by the subjective evaluation of residual enhancement in medical images (magnetic resonance imaging [MRI]). Furthermore, objective evidence defining the optimal time to acquire the images is lacking. We analyzed 144 patients with glioblastoma, objectively quantified the enhancing residual tumor through computational image analysis and assessed the correlation with survival. Pathological enhancement thickness on post-surgical MRI correlated with survival (hazard ratio: 1.98, p < 0.001). The prognostic value of several imaging and clinical variables was analyzed individually and combined (radiomics AUC 0.71, p = 0.07; combined AUC 0.72, p < 0.001). Residual enhancement thickness and radiomics complemented clinical data for prognosis stratification in patients with glioblastoma. Significant results were only obtained for scans performed between 24 and 72 h after surgery, raising the possibility of confounding non-tumor enhancement in very early post-surgery MRI. Regarding the extent of resection, and in agreement with recent studies, the association between the measured tumor remnant and survival supports maximal safe resection whenever possible.

The Impact of Postoperative Tumor Burden on Patients With Brain Metastases

“…All early (within 72 h) postoperative (T1-weighted, with and without gadolinium contrast-media) MRIs were evaluated, and residual tumor remnants were detected. As in the case of glioblastomas, the importance of postoperative precise enhancement quantification has already been demonstrated well, and any discussable contrast-media-active or subsequent postoperative reactive barrier disturbances were classified as remnants ( 21 ). An experienced neuroradiologist (BW, 11 years of experience) and neurosurgeon (AA, 7 years of experience) performed volumetric measurements.…”

Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review

“…Similarly, a recent study analysed the postoperative window in association with survival using image processing and radiomics. Postoperative enhancement thickness correlated with survival on scans performed between 24 and 72 h after surgery [32].…”

“…Reason for Exclusion Aprile et al, (2008) [37] Only perfusion MRI Belhawi et al, (2010) [8] Only T2-weighted/FLAIR MRI Boyett et al, (2019) [38] Conference abstract Brochado et al, (2012) [39] Conference abstract Colen et al, (2012) [40] Abstract only Fei et al, (2020) [41] Only diffusion/perfusion MRI Finck et al, (2020) [42] Only black-blood MRI sequence Florez et al, (2020) [43] Conference abstract Garcia-Ruiz et al, (2021) [32] No data for patterns of contrast enhancements Heßelmann et al, (2017) [44] No data for patterns of contrast enhancements Lescher et al, (2016) [45] Only FLAIR MRI [46] Conference abstract Majos et al, (2016) [5] No data for patterns of contrast enhancements Martin et al, (2000) [47] No data for patterns of contrast enhancements Özduman et al, (2014) [48] Only dynamic contrast enhanced (DCE)-MRI Appendix B…”

Migration Capacity of Stem Cells from Human Exfoliated Deciduous Teeth Towards Glioma

“…Additionally, the evolution of awake surgery, devices that improve tumor removal rates, and advances in radiation technology have remarkably improved clinical outcomes. Nevertheless, the 5-year survival rate for glioblastoma remains only 6.8% [1], and recurrences from any remnant tumor after treatment will affect prognosis [2]. Therefore, localized treatment is required to completely destroy all residual tumor cells, particularly any that have invaded the surrounding normal brain tissue.…”