Prognostic value of combined visualization of MR diffusion and perfusion maps in glioblastoma

Abstract

We analyzed whether the combined visualization of decreased apparent diffusion coefficient (ADC) values and increased cerebral blood volume (CBV) in perfusion imaging can identify prognosis-related growth patterns in patients with newly diagnosed glioblastoma. Sixty-five consecutive patients were examined with diffusion and dynamic susceptibility-weighted contrast-enhanced perfusion weighted MRI. ADC and CBV maps were co-registered on the T1-w image and a region of interest (ROI) was manually delineated encompassing the enhancing lesion. Within this ROI pixels with ADC values <the 30th percentile (ADCmin), pixels with CBV values >the 70th percentile (CBVmax) and the intersection of pixels with ADCmin and CBVmax were automatically calculated and visualized. Initially, all tumors with a mean intersection greater than the upper quartile of the normally distributed mean intersection of all patients were subsumed to the first growth pattern termed big intersection (BI). Subsequently, the remaining tumors' growth patterns were categorized depending on the qualitative representation of ADCmin, CBVmax and their intersection. Log-rank test exposed a significantly longer overall survival of BI (n = 16) compared to non-BI group (n = 49) (p = 0.0057). Thirty-one, four and 14 patients of the non-BI group were classified as predominant ADC-, CBV- and mixed growth group, respectively. In a multivariate Cox regression model, the BI-, CBV- and mixed groups had significantly lower adjusted hazard ratios (p-value, α(Bonferroni) < 0.006) when compared to the reference group ADC: 0.29 (0.0027), 0.11 (0.038) and 0.33 (0.0059). Our study provides evidence that the combination of diffusion and perfusion imaging allows visualization of different glioblastoma growth patterns that are associated with prognosis. A possible biological hypothesis for this finding could be the interpretation of the ADCmin fraction as the invasion-front of tumor cells while the CBVmax fraction might represent the vascular rich tumor border that is "trailing behind" the invasion-front in the ADC group.

Survival Associations Using Perfusion and Diffusion Magnetic Resonance Imaging in Patients With Histologic and Genetic Defined Diffuse Glioma World Health Organization Grades II and III

“…Several previous reports have focused on the usefulness of both PWI and DWI in unselected glioma patients to differentiate histopathologic grades and, more recently, for stratifying patients into prognostic groups 17,32,36,[38][39][40][41] . However, distinguishing different histopathologic grades and survival times in patients with diffuse glioma grade II and grade III, especially oligodendroglial tumors, is challenging with considerable overlap between groups.…”

Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps

“…ADC maps and T1w images were coregistered using a linear rigid registration algorithm based on mutual information followed by visual inspection to ensure adequate alignment [27,28]. …”

3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in the Preoperative Evaluation of Gliomas

“…GBMs with high relative CBV were significantly associated with a poor OS, while another study by Deike et al 45 in 2016 suggested that GBMs with a low blood supply may be associated with poor OS. The difference in results between these studies may be due to the different postoperative treatment strategies.…”