Post-treatment changes of tumour perfusion parameters can help to predict survival in patients with high-grade astrocytoma

• Published in: European radiology 2017-08, Vol.27 (8), p.3392-3400
• Main Authors: Sanz-Requena, Roberto, Revert-Ventura, Antonio J., García-Martí, Gracián, Salamé-Gamarra, Fares, Pérez-Girbés, Alexandre, Mollá-Olmos, Enrique, Martí-Bonmatí, Luis
• Format: Article
• Language: English
• Subjects: Adult; Aged; Astrocytoma; Astrocytoma - blood supply; Astrocytoma - diagnostic imaging; Astrocytoma - pathology; Astrocytoma - therapy; Blood flow; Blood volume; Brain Neoplasms - blood supply; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Brain tumors; Cerebral blood flow; Cerebrovascular Circulation; Combined Modality Therapy; Confidence intervals; Diagnostic Radiology; Female; Glioma; Humans; Imaging; Internal Medicine; Interventional Radiology; Kaplan-Meier Estimate; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Mathematical analysis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neovascularization, Pathologic - diagnostic imaging; Neuroradiology; Oncology; Patients; Perfusion; Prognosis; Quality; Radiology; Retrospective Studies; Stagnation; Surgery; Survival; Survival analysis; Transit time; Ultrasound; Variance analysis
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4699-2

Objectives Vascular characteristics of tumour and peritumoral volumes of high-grade gliomas change with treatment. This work evaluates the variations of T2*-weighted perfusion parameters as overall survival (OS) predictors. Methods Forty-five patients with histologically confirmed high-grade astrocytoma (8 grade III and 37 grade IV) were included. All patients underwent pre- and post-treatment T2*-weighted contrast-enhanced magnetic resonance (MR) imaging. Tumour, peritumoral and control volumes were segmented. Relative variations of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), K trans-T2* , k ep-T2* , v e-T2* and v p-T2* were calculated. Differences regarding tumour grade and surgical resection extension were evaluated with ANOVA tests. For each parameter, two groups were defined by non-supervised clusterisation. Survival analysis were performed on these groups. Results For the tumour region, the 90th percentile increase or stagnation of CBV was associated with shorter survival, while a decrease related to longer survival (393 ± 189 vs 594 ± 294 days; log-rank p  = 0.019; Cox hazard-ratio, 2.31; 95% confidence interval [CI], 1.12-4.74). K trans-T2* showed similar results (414 ± 177 vs 553 ± 312 days; log-rank p  = 0.037; hazard-ratio, 2.19; 95% CI, 1.03-4.65). The peritumoral area values showed no relationship with OS. Conclusions Post-treatment variations of the highest CBV and K trans-T2* values in the tumour volume are predictive factors of OS in patients with high-grade gliomas. Key Points • Vascular characteristics of high-grade glioma tumour and peritumoral regions change with treatment. • Quantitative assessment of MRI perfusion provides valuable information regarding tumour aggressiveness. • Quantitative T2*-weighted perfusion parameters can help to predict overall survival. • Post-treatment variations of CBV and K trans-T2 values are predictive factors of OS. • Increased values may justify treatment intensification in these patients.