Abstract
Objectives
Prediction of progression-free survival (PFS) and overall survival (OS) and early identification of molecular biomarkers with prognostic information are clinically important in glioblastoma (GBM) patients. We aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI) in the prediction of molecular biomarkers and survival in GBM patients.
Methods
We retrospectively analyzed 149 consecutive GBM patients, who had undergone maximal surgical resection or biopsy followed by concurrent chemoradiotherapy and adjuvant chemotherapy using temozolomide between November 2010 and June 2016. On preoperative ASL-PWI, cerebral blood flow (CBF) within contrast-enhancing (CE) and nonenhancing (NE) portions were evaluated both qualitatively (perfusion pattern[CE] and perfusion pattern[NE]) and quantitatively (nCBFCE and nCBFNE). ASL-PWI findings were correlated with molecular biomarkers, including isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT) methylation statuses, and survival, using the Mann-Whitney U-test, Spearman rank correlation, Kaplan-Meier analysis, and receiver operating characteristics analysis.
Results
nCBFCE was significantly higher in the IDH wild-type group than in the IDH mutant group (p = .013) and in the MGMT unmethylated group than in the methylated group (p = .047). Areas under the receiver operating characteristic curve were 0.678 for IDH mutation (p = .022) and 0.601 for MGMT promoter methylation (p = .043). Hyperperfusion was associated with the shortest median PFS for both perfusion pattern[CE] (7.6 months) and perfusion pattern[NE] (4.0 months). The perfusion pattern[NE] remained an independent predictor for PFS and OS even after adjusting for clinical and molecular predictors, unlike perfusion pattern[CE].
Conclusions
ASL-PWI can aid to predict survival and molecular biomarkers including IDH mutation and MGMT promoter methylation statuses in GBM patients.
Key Points
• ASL-PWI can aid to predict survival in GBM patients.
• ASL-PWI can aid to predict IDH and MGMT promoter methylation statuses in GBM.
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Abbreviations
- ASL:
-
Arterial spin labeling
- ATRX:
-
Alpha thalassemia/mental retardation syndrome x-linked gene
- CBF:
-
Cerebral blood flow
- CBV:
-
Cerebral blood volume
- CCRT:
-
Concurrent chemo- and radiation therapy
- DSC:
-
Dynamic susceptibility contrast-enhanced
- EGFR:
-
Epidermal growth factor receptor
- FLAIR:
-
Fluid-attenuated inversion recovery
- GBM:
-
Glioblastomas
- HIF-1α:
-
Hypoxia-inducible factor 1-alpha
- HR:
-
Hazard ratio
- IDH:
-
Isocitrate dehydrogenase
- IQR:
-
Interquartile range
- KPS:
-
Karnofsky performance score
- MGMT:
-
O6-methylguanine-DNA methyltransferase
- OS:
-
Overall survival
- PFS:
-
Progression-free survival
- PWI:
-
Perfusion-weighted imaging
- RANO:
-
Response assessment in neuro-oncology
- TMZ:
-
Temozolomide
- VEGF:
-
Vascular endothelial growth factor
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Funding
This study has received funding by grants from the Seoul National University Hospital Research Funds (04-2015-0690).
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The scientific guarantor of this publication is Tae Jin Yun.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors (R.E.Y.) has significant statistical expertise.
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Requirement for informed consent was waived due to its retrospective nature.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Part of the patient population in this study (n = 132) overlaps with those in a previous study (Hong EK, Choi SH, Shin DJ et al (2018) Radiogenomics correlation between MR imaging features and major genetic profiles in glioblastoma. Eur Radiol. https://doi.org/10.1007/s00330-018-5400-8). The current study differs from the previous study in that we used ASL-PWI to conduct rigorous radiogenomics and survival analyses, focusing on both enhancing and nonenhancing portions of tumors. Moreover, the current study expands on the prior study by having a larger patient number and includes a more in-depth survival analysis using a multivariable survival model based on various imaging, molecular, and clinical predictors.
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• retrospective
• diagnostic or prognostic study
• performed at one institution
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Yoo, RE., Yun, T.J., Hwang, I. et al. Arterial spin labeling perfusion-weighted imaging aids in prediction of molecular biomarkers and survival in glioblastomas. Eur Radiol 30, 1202–1211 (2020). https://doi.org/10.1007/s00330-019-06379-2
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DOI: https://doi.org/10.1007/s00330-019-06379-2