RT Journal Article
SR Electronic
T1 Morphologic Features on MR Imaging Classify Multifocal Glioblastomas in Different Prognostic Groups
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 634
OP 640
DO 10.3174/ajnr.A6019
VO 40
IS 4
A1 J. Pérez-Beteta
A1 D. Molina-García
A1 M. Villena
A1 M.J. Rodríguez
A1 C. Velásquez
A1 J. Martino
A1 B. Meléndez-Asensio
A1 Á. Rodríguez de Lope
A1 R. Morcillo
A1 J.M. Sepúlveda
A1 A. Hernández-Laín
A1 A. Ramos
A1 J.A. Barcia
A1 P.C. Lara
A1 D. Albillo
A1 A. Revert
A1 E. Arana
A1 V.M. Pérez-García
YR 2019
UL http://www.ajnr.org/content/40/4/634.abstract
AB BACKGROUND AND PURPOSE: Multifocal glioblastomas (ie, glioblastomas with multiple foci, unconnected in postcontrast pretreatment T1-weighted images) represent a challenge in clinical practice due to their poor prognosis. We wished to obtain imaging biomarkers with prognostic value that have not been found previously.MATERIALS AND METHODS: A retrospective review of 1155 patients with glioblastomas from 10 local institutions during 2006–2017 provided 97 patients satisfying the inclusion criteria of the study and classified as having multifocal glioblastomas. Tumors were segmented and morphologic features were computed using different methodologies: 1) measured on the largest focus, 2) aggregating the different foci as a whole, and 3) recording the extreme value obtained for each focus. Kaplan-Meier, Cox proportional hazards, correlations, and Harrell concordance indices (c-indices) were used for the statistical analysis.RESULTS: Age (P < .001, hazard ratio = 2.11, c-index = 0.705), surgery (P < .001, hazard ratio = 2.04, c-index = 0.712), contrast-enhancing rim width (P < .001, hazard ratio = 2.15, c-index = 0.704), and surface regularity (P = .021, hazard ratio = 1.66, c-index = 0.639) measured on the largest focus were significant independent predictors of survival. Maximum contrast-enhancing rim width (P = .002, hazard ratio = 2.05, c-index = 0.668) and minimal surface regularity (P = .036, hazard ratio = 1.64, c-index = 0.600) were also significant. A multivariate model using age, surgery, and contrast-enhancing rim width measured on the largest foci classified multifocal glioblastomas into groups with different outcomes (P < .001, hazard ratio = 3.00, c-index = 0.853, median survival difference = 10.55 months). Moreover, quartiles with the highest and lowest individual prognostic scores based on the focus with the largest volume and surgery were identified as extreme groups in terms of survival (P < .001, hazard ratio = 18.67, c-index = 0.967).CONCLUSIONS: A prognostic model incorporating imaging findings on pretreatment postcontrast T1-weighted MRI classified patients with glioblastoma into different prognostic groups.CEcontrast-enhancingc-indexconcordance indexGBMglioblastomaHRhazard ratioIPSLVindividual prognosis score based on the focus with the largest volumeIPSLVSindividual prognosis score based on the focus with the largest volume and surgeryIPSLWindividual prognosis score based on the focus with the largest widthIPSLWSindividual prognosis score based on the focus with the largest width and surgeryMGBMmultifocal glioblastoma