Magnetic resonance diffusion metrics indexing high focal cellularity and sharp transition at the tumour boundary predict poor outcome in glioblastoma multiforme

Aim To investigate the prognostic power of intra-tumoural and gradient magnetic resonance imaging (MRI) diffusion metrics in patients with glioblastoma multiforme (GBM). Materials and methods Forty-six consecutive patients with histologically confirmed GBM who had undergone preoperative diffusion te...

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Bibliographic Details
Published in:Clinical radiology 2015-12, Vol.70 (12), p.1400-1407
Main Authors: Jamjoom, A.A.B, Rodriguez, D, Rajeb, A.T, Manita, M.A, Shah, K.A, Auer, D.P
Format: Article
Language:English
Subjects:
Brain - pathology
Brain Neoplasms - pathology
Contrast Media
Diffusion Tensor Imaging
Female
Gadolinium
Glioblastoma - pathology
Humans
Image Enhancement
Magnetic Resonance Imaging
Male
Middle Aged
Observer Variation
Proportional Hazards Models
Radiology
Reproducibility of Results
Survival Analysis
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Summary:Aim To investigate the prognostic power of intra-tumoural and gradient magnetic resonance imaging (MRI) diffusion metrics in patients with glioblastoma multiforme (GBM). Materials and methods Forty-six consecutive patients with histologically confirmed GBM who had undergone preoperative diffusion tensor imaging at 3 T were included. Mean diffusivity (MD) and MD gradient maps were computed. Regions of interest were analysed to determine the minimum MD within the enhancing tumour (minMD). MD gradients were calculated along the enhancing tumour boundary and subjected to histogram analysis. Overall survival (OS) and time to progression (TTP) were derived and survival analysis was undertaken. Results There were 31 deaths and 37 patients progressed during the study period. Multivariate survival analysis, controlling for treatment and gender, showed that minMD values4.7×10−5  mm2 /s (10th centile) had a significantly shorter OS with a HR of 0.43 (0.19–0.96; p =0.04). Similarly, a value above 1.4×10−4 mm2 /s (75th centile) was a significant predictor for shorter OS (HR=0.39, 0.17–0.89; p =0.03). Conclusions Lower minMD and higher MD gradient values for the 10th and 75th percentile of the tumour boundary demonstrated prognostic value in preoperative GBM. This suggests that MRI diffusion metrics indicative of higher focal cellularity and steeper transition from high cellular tumour edge to low cellular oedema define more aggressive glioblastoma subtypes with a poorer prognosis.
ISSN:0009-9260
1365-229X
DOI:10.1016/j.crad.2015.08.006