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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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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

View larger version (15K): [in this window] [in a new window]   Fig 1. ROC curves to determine the optimal maximum rCBV cutoff for predicting the 2-year survival. At a critical test cutoff value of rCBV = 2.3, sensitivity and specificity for distinguishing the 2-year survival are 95% and 68%, respectively. Area under the curve is 0.829.

View larger version (16K): [in this window] [in a new window]   Fig 2. The relationship between maximum rCBV values and survival time in 49 patients with high-grade astrocytoma. A cutoff value of 2.3 for maximum rCBV (dotted line) was determined on the basis of an ROC analysis result to best discriminate patients with and without 2-year survival. indicates surviving patients with AA; •, patients with AA who died; , surviving patients with GBM; , patients with GBM who died.

View larger version (21K): [in this window] [in a new window]   Fig 3. Kaplan-Meier survival curves for patients with GBM or AA with low rCBV (2.3) or high rCBV (>2.3). For patients with GBM and AA, the overall survival rate was significantly lower for patients with high rCBV (>2.3) than for those with low rCBV (2.3) (P = .013 and P < .001, respectively). indicates surviving patients with AA; •, patients with AA who died; , surviving patients with GBM; , patients with GBM who died.

View larger version (66K): [in this window] [in a new window]   Fig 4. Transverse MR images obtained in a 71-year-old woman with anaplastic astrocytoma. A and B, T2-weighted (A) (TR/TE, 3600/96 ms) and contrast-enhanced T1-weighted (B) (TR/TE, 670/14 ms) images showing a heterogeneous signal-intensity lesion with slightly enhanced areas in the left basal ganglia. C, Transverse rCBV map showing intratumoral high-perfusion areas (arrow). The maximum rCBV value within the tumor is 2.4. This patient died 25 months after the initial MR imaging study.

View larger version (58K): [in this window] [in a new window]   Fig 5. Transverse MR images obtained in a 43-year-old woman with anaplastic astrocytoma. A and B, T2-weighted (A) (TR/TE, 3600/96 ms) and contrast-enhanced T1-weighted (B) (TR/TE, 670/14 ms) images showing a heterogeneous signal-intensity lesion with patchy enhanced areas in the left temporal lobe. C, Transverse rCBV map showing slight high-perfusion areas (arrow) in the medial portion of the temporal lesion. The maximum rCBV value within the tumor is 1.9. This patient survived 65 months after the initial MR imaging study.