Burth Sina, Kickingereder Philipp, Eidel Oliver, Tichy Diana, Bonekamp David, Weberling Lukas, Wick Antje, Löw Sarah, Hertenstein Anne, Nowosielski Martha, Schlemmer Heinz-Peter, Wick Wolfgang, Bendszus Martin, Radbruch Alexander
Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany (S.B., P.K., O.E., D.B., L.W., M.B., A.R.); Division of Bioststatistics, German Cancer Research Center, Heidelberg, Germany (D.T.); Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany (A.W., S.L., A.H., W.W.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (M.N.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (H.S.).
Neuro Oncol. 2016 Dec;18(12):1673-1679. doi: 10.1093/neuonc/now122. Epub 2016 Jun 13.
The purpose of this study was to determine the relevance of clinical data, apparent diffusion coefficient (ADC), and relative cerebral blood volume (rCBV) from dynamic susceptibility contrast (DSC) perfusion and the volume transfer constant (k) from dynamic contrast-enhanced (DCE) perfusion for predicting overall survival (OS) and progression-free survival (PFS) in newly diagnosed treatment-naïve glioblastoma patients.
Preoperative MR scans including standardized contrast-enhanced T1 (cT1), T2 - fluid-attenuated inversion recovery (FLAIR), ADC, DSC, and DCE of 125 patients with subsequent histopathologically confirmed glioblastoma were performed on a 3 Tesla MRI scanner. ADC, DSC, and DCE parameters were analyzed in semiautomatically segmented tumor volumes on contrast-enhanced (CE) cT1 and hyperintense signal changes on T2 FLAIR (ED). Univariate and multivariable Cox regression analyses including age, sex, extent of resection (EOR), and KPS were performed to assess the influence of each parameter on OS and PFS.
Univariate Cox regression analysis demonstrated a significant association of age, KPS, and EOR with PFS and age, KPS, EOR, lower ADC, and higher rCBV with OS. Multivariable analysis showed independent significance of male sex, KPS, EOR, and increased rCBV for PFS, and age, sex, KPS, and EOR for OS.
MRI parameters help to predict OS in a univariate Cox regression analysis, and increased rCBV is associated with shorter PFS in the multivariable model. In summary, however, our findings suggest that the relevance of MRI parameters is outperformed by clinical parameters in a multivariable analysis, which limits their prognostic value for survival prediction at the time of initial diagnosis.
本研究的目的是确定临床数据、表观扩散系数（ADC）、动态磁敏感对比（DSC）灌注的相对脑血容量（rCBV）以及动态对比增强（DCE）灌注的容积转运常数（k）对新诊断的未经治疗的胶质母细胞瘤患者总生存期（OS）和无进展生存期（PFS）预测的相关性。
对125例随后经组织病理学确诊为胶质母细胞瘤的患者，在3特斯拉MRI扫描仪上进行术前磁共振扫描，包括标准化对比增强T1（cT1）、T2加权液体衰减反转恢复序列（FLAIR）、ADC、DSC和DCE。在对比增强（CE）cT1上半自动分割的肿瘤体积以及T2 FLAIR上的高信号变化（ED）中分析ADC、DSC和DCE参数。进行单因素和多因素Cox回归分析，包括年龄、性别、切除范围（EOR）和KPS，以评估每个参数对OS和PFS的影响。
单因素Cox回归分析显示，年龄、KPS和EOR与PFS显著相关，年龄、KPS、EOR、较低的ADC和较高的rCBV与OS显著相关。多因素分析显示，男性、KPS、EOR和rCBV升高对PFS具有独立意义，年龄、性别、KPS和EOR对OS具有独立意义。
在单因素Cox回归分析中，MRI参数有助于预测OS，在多变量模型中，rCBV升高与较短的PFS相关。然而，总的来说，我们的研究结果表明，在多变量分析中，MRI参数的相关性不如临床参数，这限制了它们在初始诊断时对生存预测的预后价值。
