Multimodal MRI characteristics of the glioblastoma infiltration beyond contrast enhancement.
Boonzaier, Natalie R
Fountain, Daniel M
Larkin, Timothy J
van der Hoorn, Anouk
Therapeutic Advances in Neurological Disorders
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Yan, J., Li, C., Boonzaier, N. R., Fountain, D. M., Larkin, T. J., Matys, T. M., van der Hoorn, A., & et al. (2019). Multimodal MRI characteristics of the glioblastoma infiltration beyond contrast enhancement.. Therapeutic Advances in Neurological Disorders, 12 https://doi.org/10.1177/1756286419844664
Our inability to identify the invasive margin of glioblastomas hampers attempts to achieve local control. Diffusion tensor imaging (DTI) has been implemented clinically to delineate the margin of the tumor infiltration, its derived anisotropic (q) values can extend beyond the contrast-enhanced area and correlates closely with the tumor. However, its correlation with tumor infiltration shown on multivoxel proton magnetic resonance spectroscopy1 (MRS) and perfusion magnetic resonance imaging (MRI) should be investigated. In this study, we aimed to show tissue characteristics of the q-defined peritumoral invasion on MRS and perfusion MRI. Patients with a primary glioblastoma were included (n = 51). Four regions of interest were analyzed; the contrast-enhanced lesion, peritumoral abnormal q region, peritumoral normal q region, and contralateral normal-appearing white matter. MRS, including choline (Cho)/creatinine (Cr), Cho/N-acetyl-aspartate (NAA) and NAA/Cr ratios, and the relative cerebral blood volume (rCBV) were analyzed. Our results showed an increase in the Cho/NAA (p = 0.0346) and Cho/Cr (p = 0.0219) ratios in the peritumoral abnormal q region, suggestive of tumor invasion. The rCBV was marginally elevated (p = 0.0798). Furthermore, the size of the abnormal q regions was correlated with survival; patients with larger abnormal q regions showed better progression-free survival (median 287 versus 53 days, p = 0.001) and overall survival (median 464 versus 274 days, p = 0.006) than those with smaller peritumoral abnormal q regions of interest. These results support how the DTI q abnormal area identifies tumor activity beyond the contrast-enhanced area, especially correlating with MRS.
MR spectroscopy, MRI, diffusion tensor imaging, glioblastoma, peritumoral area
This study is funded by the UK National Institute of Health Research Clinician Scientist Fellowship (SJP) and grants from Chang Gung Medical Foundation and Chang Gung Memorial Hospital (JLY), Cambridge Trust and China Scholarship Council (CL), the Remmert Adriaan Laan Fund and the René Vogels Fund (AH), and the Commonwealth Scholarship Commission and Cambridge Commonwealth Overseas Trust (NRB).
External DOI: https://doi.org/10.1177/1756286419844664
This record's URL: https://www.repository.cam.ac.uk/handle/1810/297107
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Licence URL: https://creativecommons.org/licenses/by-nc/4.0/