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. 2013 Aug;26(4):385-95.
doi: 10.1177/197140091302600404. Epub 2013 Aug 27.

Correlation between cerebral blood volume measurements by perfusion-weighted magnetic resonance imaging and two-year progression-free survival in gliomas

M V Spampinato  1 , C Schiarelli, A Cianfoni, P Giglio, C T Welsh, S Bisdas, Z Rumboldt
Affiliations

Correlation between cerebral blood volume measurements by perfusion-weighted magnetic resonance imaging and two-year progression-free survival in gliomas

M V Spampinato et al. Neuroradiol J. 2013 Aug.

Abstract

Our goal was to determine whether relative cerebral blood volume (rCBV) can serve as an adjunct to histopathologic grading in the assessment of gliomas, with the hypothesis that rCBV can predict two-year survival. We evaluated 29 newly diagnosed gliomas (13 WHO grade II, seven grade III, nine grade IV; 17 astrocytomas, 12 oligodendroglial tumors). Dynamic susceptibility-weighted contrast-enhanced perfusion MR images and CBV maps were obtained. rCBVmax measurements (maximum tumor CBV/contralateral normal tissue CBV) and progression-free survival (PFS) were recorded. Receiver operating characteristic curves and Kaplan-Meier survival curves were calculated for rCBVmax and histologic grade. rCBVmax measurements differed between gliomas without (2.38 +/- 1.22) and with progression (5.57 +/- 2.84) over two years. The optimal rCBVmax cut-off value to predict progression was 2.95. rCBVmax < 2.95 was a significant predictor of two-year PFS, almost as accurate as WHO grade II. In the pure astrocytoma subgroup, the optimal rCBVmax cut-off value to predict progression was 2.85. In this group rCBVmax < 2.85 was a significant predictor of two-year PFS, an even better predictor of two-year PFS than WHO grade II. rCBVmax can be used to predict two-year PFS in patients with gliomas, independent of pathologic findings, especially in tumors without oligodendroglial components.

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Figures

Figure 1
Figure 1
Low grade astrocytoma: axial FLAIR (A), post-contrast T1-weighted (B) images, and corresponding relative cerebral blood volume (CBV) map (C) demonstrate a left basal ganglia mass with subtle punctate areas of enhancement and without increased CBV. There was no progression of disease during two years of follow-up.
Figure 2
Figure 2
Glioblastoma multiforme: axial FLAIR (A), post-contrast T1-weighted (B) images, and corresponding relative CBV map (C) demonstrate a relatively homogenous and well-defined right basal ganglia mass with only a few ill-defined foci of enhancement (small arrows), but with increased CBV (large arrow). There was progression of disease within 90 days.
Figure 3
Figure 3
Scatter plot of relative cerebral blood volume max versus progression-free survival in days by WHO grade.
Figure 4
Figure 4
Region operating characteristic (ROC) curve of normalized maximal relative cerebral blood volume (rCBV) and World Health Organization grading (WHO) versus 2-year progression-free survival in all gliomas (N = 29). AUC = area under the curve.
Figure 5
Figure 5
Survival curves were generated for all gliomas using (A) dichotomized perfusion values (threshold of normalized maximal relative cerebral blood volume = 2.95); (B) histological grading (WHO = II versus WHO = III-IV).
Figure 6
Figure 6
Region operating characteristic (ROC) curve of relative maximal cerebral blood volume and World Health Organization grading (WHO) versus 2-year progression-free survival in pure astrocytic tumors (N = 17). AUC = area under the curve.
Figure 7
Figure 7
Survival curves were generated for pure astrocytic tumors using (A) dichotomized perfusion values (threshold of relative maximal cerebral blood volume = 2.85); (B) histological grading (WHO = II versus WHO =III-IV).
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