Survival prediction in high-grade gliomas using CT perfusion imaging

Abstract

Patients with high-grade gliomas usually have heterogeneous response to surgery and chemoirradiation. The objectives of this study were (1) to evaluate serial changes in tumor volume and perfusion imaging parameters and (2) to determine the value of these data in predicting overall survival (OS). Twenty-nine patients with World Health Organization grades III and IV gliomas underwent magnetic resonance (MR) and computed tomography (CT) perfusion examinations before surgery, and 1, 3, 6, 9, and 12 months after radiotherapy. Serial measurements of tumor volumes and perfusion parameters were evaluated by receiver operating characteristic analysis, Cox proportional hazards regression, and Kaplan-Meier survival analysis to determine their values in predicting OS. Higher trends in blood flow (BF), blood volume (BV), and permeability-surface area product in the contrast-enhancing lesions (CEL) and the non-enhancing lesions (NEL) were found in patients with OS \ 18 months compared to those with OS C 18 months, and these values were significant at selected time points (P \ 0.05). Only CT perfusion parameters yielded sensitivities and specificities of C70 % in predicting 18 and 24 months OS. Pre-surgery BF in the NEL and BV in the CEL and NEL 3 months after radiotherapy had sensitivities and specificities [80 % in predicting 24 months OS in patients with grade IV gliomas. Our study indicated that CT perfusion parameters were predictive of survival and could be useful in assessing early response and in selecting adjuvant treatment to prolong survival if verified in a larger cohort of patients.

Dynamic perfusion CT in brain tumors

“…Yeung et al showed that patients with shorter OS had higher BV and PS in both regions than patients with longer OS (Fig. 6), and that post-radiotherapy BV in the peritumoral edema region could predict 24 months OS with sensitivities and specificities >80% [46]. Similar results have been demonstrated in DSC-MR studies [47,48].…”

Evaluation of CT Perfusion Biomarkers of Tumor Hypoxia

“…The CT perfusion imaging was performed on a clinical CT scanner (Discovery 750 HD, GE Healthcare, Waukesha, WI) according to previous work [ 16 ]. A two-phase CT perfusion scan, guided by a prior non-contrast CT scan that identified sixteen 1.25 mm thick sections to cover the entire brain, was performed for each animal.…”

“…The changes in CT numbers as a function of time can be measured using the dynamic series of CT perfusion images. After glioma cells implantation, baseline images were obtained on an average of 11 days (7–16 days) when the diameter of the tumor reached 4 mm [ 16 ]. Stereotactic radiosurgery (SRS) is an effective technique that delivers one or a few high dose (8–30 Gy) radiation per fraction [ 18 , 19 ] Rats were randomly assigned to control ( N = 18), acute response to SRS (Group SRS1, N = 6), and serial imaging after SRS (Group SRS2, N = 13) groups.…”

Brain Vascular Imaging Techniques

“…Published data have suggested that perfusion CT might be comparable to MRI [ 33 , 34 ]. Moreover, perfusion CT has been used to evaluate possible clinical benefits of pharmacology therapy in early stroke onset [ 35 ], as well as to predict survival in in high-grade gliomas [ 36 ].…”