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AJNR - American Journal of Neuroradiology

Published ahead of print on June 12, 2008
doi: 10.3174/ajnr.A1121

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American Journal of Neuroradiology 29:1505-1510, September 2008
© 2008 American Society of Neuroradiology

BRAIN

Prognostic Value of Perfusion MR Imaging of High-Grade Astrocytomas: Long-Term Follow-Up Study

T. Hirai^a, R. Murakami^b, H. Nakamura^c, M. Kitajima^a, H. Fukuoka^a, A. Sasao^a, M. Akter^a, Y. Hayashida^a, R. Toya^b, N. Oya^b, K. Awai^a, K. Iyama^d, J.-i. Kuratsu^c and Y. Yamashita^a

^a Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^b Department of Radiation Oncology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^c Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^d Department of Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

Please address correspondence to Toshinori Hirai, MD, Department Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan; e-mail: t-hirai{at}kumamoto-u.ac.jp

BACKGROUND AND PURPOSE: Although the prognostic value of perfusion MR imaging in various gliomas has been investigated, that in high-grade astrocytomas alone has not been fully evaluated. The purpose of this study was to evaluate retrospectively whether the tumor maximum relative cerebral blood volume (rCBV) on pretreatment perfusion MR imaging is of prognostic value in patients with high-grade astrocytoma.

MATERIALS AND METHODS: Between January 1999 and December 2002, 49 patients (30 men, 19 women; age range, 23–76 years) with supratentorial high-grade astrocytoma underwent MR imaging before the inception of treatment. The patient age, sex, symptom duration, neurologic function, mental status, Karnofsky Performance Scale, extent of surgery, histopathologic diagnosis, tumor component enhancement, and maximum rCBV were assessed to identify factors affecting survival. Kaplan-Meier survival curves, the logrank test, and the multivariate Cox proportional hazards model were used to evaluate prognostic factors.

RESULTS: The maximum rCBV was significantly higher in the 31 patients with glioblastoma multiforme than in the 18 with anaplastic astrocytoma (P < .03). The 2-year overall survival rate was 67% for 27 patients with a low (2.3) and 9% for 22 patients with a high (>2.3) maximum rCBV value (P < .001). Independent important prognostic factors were the histologic diagnosis (hazard ratio = 9.707; 95% confidence interval (CI), 3.163–29.788), maximum rCBV (4.739; 95% CI, 1.950–11.518), extent of surgery (2.692; 95% CI, 1.196–6.061), and sex (2.632; 95% CI, 1.153–6.010).

CONCLUSION: The maximum rCBV at pretreatment perfusion MR imaging is a useful clinical prognostic biomarker for survival in patients with high-grade astrocytoma.