Characterizing tumor invasiveness of glioblastoma using multiparametric magnetic resonance imaging.
Boonzaier, Natalie R
Journal of neurosurgery
American Association of Neurological Surgeons
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Li, C., Wang, S., Yan, J., Torheim, T., Boonzaier, N. R., Sinha, R., Matys, T., et al. (2019). Characterizing tumor invasiveness of glioblastoma using multiparametric magnetic resonance imaging.. Journal of neurosurgery, 1-8. https://doi.org/10.3171/2018.12.jns182926
Objective To characterize the abnormalities revealed by diffusion tensor imaging (DTI) using magnetic resonance spectroscopy and perfusion imaging, and to evaluate the prognostic value of a proposed quantitative measure of tumor invasiveness by combining contrast-enhancing and DTI abnormalities in glioblastoma patients. Methods Eighty-four glioblastoma patients were recruited pre-operatively. DTI was decomposed into isotropic (p) and anisotropic (q) components. The relative cerebral blood volume (rCBV) were calculated from the dynamic susceptibility contrast imaging. Values of N-acetyl aspartate (NAA), myoinositol (mIns), choline (Cho), lactate (Lac) and glutamate + glutamine (Glx) were measured from multivoxel magnetic resonance spectroscopy and normalized as ratios to creatine (Cr). Tumor regions of interest (ROIs) were manually segmented from the contrast-enhancing T1-weighted (CE-ROI) and DTI-q (q-ROI) maps. Perfusion and metabolic characteristics of above ROIs were measured and compared. Relative invasiveness coefficient (RIC) was calculated as a ratio of the characteristics radius of CE-ROI and q-ROI. The prognostic significance of RIC was tested using Kaplan-Meier and multivariate Cox regression analyses. Results The Cho/Cr, Lac/Cr and Glx/Cr in q-ROI were significantly higher than CE-ROI (P = 0.004, P = 0.005 and P = 0.007, respectively). CE-ROI had significantly higher rCBV values than q-ROI (P < 0.001). A higher RIC was associated with worse survival in multivariate overall survival (OS) model (hazard ratio [HR] = 1.40, 95% CI: 1.06-1.85, P = 0.016) and progression-free survival (PFS) model (HR = 1.55, 95% CI: 1.16-2.07, P = 0.003). An RIC cutoff value of 0.89 significantly predicted shorter OS (median 244 and 384 days, respectively; P = 0.002) and PFS (median 406 and 605 days, respectively; P = 0.001). Conclusions DTI-q abnormalities displayed higher tumor load and hypoxic signatures compared to contrast-enhancing abnormalities, whereas contrast enhancing regions potentially represented the proliferation front. Integrating the invasion extents of DTI-q and contrast enhancing volume into clinical practice may lead to improved treatment efficacy.
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External DOI: https://doi.org/10.3171/2018.12.jns182926
This record's URL: https://www.repository.cam.ac.uk/handle/1810/290738