ABSTRACT
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), Ktrans-T2*, kep-T2*, ve-T2* and vp-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). Ktrans-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 Ktrans-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.
Subject(s)
Astrocytoma/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Neovascularization, Pathologic/diagnostic imaging , Adult , Aged , Astrocytoma/blood supply , Astrocytoma/pathology , Astrocytoma/therapy , Brain Neoplasms/blood supply , Brain Neoplasms/pathology , Brain Neoplasms/therapy , Cerebrovascular Circulation , Combined Modality Therapy , Female , Humans , Kaplan-Meier Estimate , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Grading , Perfusion , Prognosis , Retrospective StudiesSubject(s)
Acetazolamide/therapeutic use , Carbonic Anhydrase Inhibitors/therapeutic use , Hydrocephalus/drug therapy , Aged , Brain/diagnostic imaging , Brain/pathology , Chronic Disease , Cognition Disorders/etiology , Female , Humans , Hydrocephalus/complications , Hydrocephalus/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Urinary Incontinence/etiologyABSTRACT
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