Bright Edge Sign on High b-Value Diffusion-Weighted Imaging as a New Imaging Biomarker to Predict Poor Prognosis in Glioma Patients: A Retrospective Pilot Study.

To investigate the prognostic value of bright edge sign observed on high b-value diffusion-weighted imaging (DWI) map in glioma patients. We retrospectively reviewed our prospectively collected database for gliomas. Bright edge sign was defined as the presence of extremely high signal in tumor margin on high b-value DWI map ( = 3,000 s/mm) with the signal intensity higher than those in contralateral normal white matter and tumor central region. Extremely poor prognosis was defined as overall survival time < 9 months. Survival analyses were conducted by using the Cox regression for both the univariable and multivariable analyses. A total of 52 patients were enrolled (WHO IV, 25; WHO III, 13; WHO II, 14). Bright edge sign presented in 10 (19.2%) patients (WHO IV, 5; WHO III, 3; WHO II, 2). Nine (90.0%) patients with bright edge sign had extremely poor prognosis, while only 1 (2.4 %) patient without bright edge sign had extremely poor prognosis. The sensitivity and specificity of bright edge sign in determining extremely poor prognosis were 90 and 97.7%, respectively. Bright edge sign (HR [95% CI] = 25.11 [7.26-86.81], < 0.001) was an independent predictor of poor prognosis after adjustment. Bright edge sign on high b-value DWI may be an accurate predictor of extremely poor prognosis in glioma patients, regardless of pathologic grades.