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AJNR - American Journal of Neuroradiology

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Prognostic Factors in Recurrent Glioblastoma Multiforme and Anaplastic Astrocytoma Treated with Selective Intra-arterial Chemotherapy

Kira L. Chow^a, Y. Pierre Gobin^,a, Timothy Cloughesy^a, James W. Sayre^a, J. Pablo Villablanca^a and Fernando Viñuela^a

^a From the University of California in Los Angeles Medical Center, B7–146A CHS 172115, 10833 Le Conte Ave, Los Angeles, CA 90095–1721.

View larger version (78K): [in a new window]   FIG 1. Hypervascular tumor. Right carotid artery angiogram shows displacement of the branches of the middle cerebral artery. The tumor blush is indicated by the arrows.FIG 2. Hypovascular tumor. Right carotid artery angiogram shows no tumor blush. The mass effect exerted by the tumor causes displacement of the insular branches of the middle cerebral artery as they enter the Sylvian triangle

View larger version (101K): [in a new window]   FIG 3. These MR scans show regions of interest manually traced on digitized scans to obtain volume measurements. Enhancing tumor is outlined in yellow and T2 signal abnormalities are outlined in pink. A, Contrast-enhanced T1-weighted sequence shows a small enhancing tumor in the left anterior parietal area. B, T2-weighted sequence shows a large and irregularly shaped hyperintensity representing tumor edema

View larger version (109K): [in a new window]   FIG 4. These MR imaging scans show regions of interest manually traced on digitized scans to obtain volume measurements. Enhancing tumor is outlined in yellow; resection cavity, central necrosis, and cystic fluid are outlined together in green; and T2 signal abnormalities are outlined in pink. A, Contrast-enhanced T1-weighted sequence shows a rounded, enhancing, tumor volume with central necrosis in the right insular region. B, T2-weighted sequence shows a large hyperintensity representing total tumor, resection cavity, and edema volume. Note the very irregular shape that is neither spherical nor ellipsoid. The computerized volume-rendering program better approximates volume than the commonly used cross-product method, which assumes the shape of the volume is spherical or ellipsoid

View larger version (9K): [in a new window]   FIG 5. The estimated survival function using the Cox proportional hazards model and the mean value covariate pattern (days to recurrence, net tumor volume) for hypervascular and hypovascular tumors shows survival in 39 patients (those whose angiographic data were available) with recurrent primary brain tumors treated with selective intra-arterial chemotherapy. The y-axis shows percentage of patients surviving. The x-axis shows survival in days. Patients with angiographic findings of hypovascularity are represented by the upper line. Those with angiographic findings of vascularity are represented by the lower line