Glioblastoma treated with postoperative radio-chemotherapy: Prognostic value of apparent diffusion coefficient at MR imaging
Introduction
Glioblastoma is the most common malignant primary neoplasm of the central nervous system; median survival is approximately 1 year [1], [2]. Conventional magnetic resonance imaging (MRI) can yield information on the gross anatomic structure of glioblastoma, but it provides little functional information. Diffusion-weighted (DW) MRI enables the volumetric intravoxel measurement of tissue characteristics based on the detection of changes in the random motion of water protons at the cellular or physiological level [3]. Although the usefulness of DW-MRI for preoperative grading and postoperative assessment of glial tumors has been investigated [4], [5], [6], [7], its value for predicting survival has not been fully addressed [8], [9], [10]. Because the apparent diffusion coefficient (ADC) is inversely related to tumor cellularity and the glioma grade [4], [6], [11], [12], [13], [14], we postulated that it reflects the biological viability and prognosis of glioblastomas. We therefore analyzed the ADC with respect to the surgical resection status and compared the mean, minimum, and maximum ADC (ADCmean, ADCMIN, and ADCMAX, respectively) values as factors reflecting biological activity. We performed a retrospective study to determine whether these values obtained on preoperative MRI scans are of prognostic value in patients with glioblastoma. We discovered that the ADCMIN value is a prognostic factor for survival in patients with glioblastomas that are not totally resectable.
Section snippets
Materials and methods
The institutional review board of our hospital approved this retrospective study and waived the requirement for informed patient consent. Patient information was kept confidential by removing all identifiers from our records at the completion of our analyses.
Patients, diagnosis and treatment
Between February 1998 and January 2006, 49 patients (29 males, 20 females) with histologically confirmed supratentorial glioblastoma were treated at our institution. Of these, 16 were excluded from this study for reasons such as incomplete MRI, progression from anaplastic or low-grade glioma, infratentorial tumors, and incomplete- or no postoperative irradiation or chemotherapy. The remaining 33 patients (24 males, 9 females; age range 10–76 years) with new, histologically confirmed
MRI study and image interpretation
All MRI scans were performed using a 1.5-T superconducting system (Signa Horizon; GE Medical Systems, Milwaukee, WI, USA) with a circularly polarized head coil. All patients underwent MRI studies that included at least unenhanced and contrast-enhanced transverse T1-weighted-, unenhanced transverse T2-weighted-, unenhanced transverse fluid-attenuated inversion-recovery (FLAIR)-, and unenhanced transverse DW images. The transverse T1-weighted spin–echo MR sequence was performed using the
Statistical analyses
Survival was measured from the time of operation to the time of death or last follow-up (range, 3.6–54.4 months; median, 16.6 months). Of the 33 patients, 6 were alive at the time of the latest follow-up. We used the median of ADCmean, ADCMIN, and ADCMAX as the cutoff value. We also applied a categorization cutoff of 1.0 × 10−3 mm2/s because earlier studies used this value [4], [10]. We analyzed the relationship between patient survival and prognostic factors determined from clinical and MRI data.
Patient characteristics and imaging
The patients ranged in age from 10 to 76 years (mean ± standard deviation (S.D.): 57.3 ± 16.3; median 62). The KPS scores were 30 and 50 in 1 patient each, 60 and 70 in 4 each, 80 in 11, 90 in 9, and 100 in 3 patients. Surgery consisted of biopsy (n = 6), partial- (n = 12), subtotal- (n = 8), and total (n = 7) tumor removal. The ADCmean of all tumors ranged from 0.716 × 10−3 to 1.389 × 10−3 mm2/s (mean ± S.D. 1.070 ± 0.141 × 10−3 mm2/s; median 1.066 × 10−3 mm2/s). The ADCMIN ranged from 0.676 × 10−3 to 1.260 × 10−3 mm2/s (mean
Discussion
Our results suggest that the ADC value of tumors, obtained from preoperative MRI scans, represents a prognostic factor in patients with glioblastoma. Although ADCmean, ADCMIN, and ADCMAX were statistically significant prognostic factors in our patients, we confirmed that ADCMIN was the most sensitive predictive factor for the overall survival of these patients. Others [9], [10] who assessed the value of the ADC for predicting the prognosis of patients with malignant astrocytic tumors used ADCMIN
Conclusions
The ADCMIN value of tumors obtained from preoperative MR images is a useful clinical prognostic biomarker for overall survival in patients with glioblastoma. Patients whose tumors have a low minimum ADC (≤1.0 × 10−3 mm2/s) may have a poor prognosis, especially when the tumor cannot be completely resected. Thus, pretreatment DW-MRI and calculating the ADC values may be helpful for planning therapy in patients with glioblastoma.
Conflicts of interest
None.
References (21)
- et al.
Primary brain tumours in adults
Lancet
(2003) - et al.
Minimum apparent diffusion coefficients in the evaluation of brain tumors
Eur J Radiol
(2005) - et al.
Normal aging in the central nervous system: quantitative MR diffusion-tensor analysis
Neurobiol Aging
(2002) Brain tumors
N Engl J Med
(2001)- et al.
MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences
AJR Am J Roentgenol
(1994) - et al.
Apparent diffusion coefficient of human brain tumors at MR imaging
Radiology
(2005) - et al.
The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors
J Comput Assist Tomogr
(2004) - et al.
The role of diffusion-weighted imaging in patients with brain tumors
AJNR Am J Neuroradiol
(2001) - et al.
Survival analysis in patients with glioblastoma multiforme: predictive value of choline-to-N-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume
J Magn Reson Imaging
(2004) - et al.
Malignant astrocytic tumors: clinical importance of apparent diffusion coefficient in prediction of grade and prognosis
Radiology
(2006)
Cited by (41)
High-Resolution Diffusion-Weighted Imaging of C6 Glioma on a 7T BioSpec MRI Scanner: Correlation of Tumor Cellularity and Nuclear-to-Cytoplasmic Ratio with Apparent Diffusion Coefficient
2022, Academic RadiologyCitation Excerpt :In this study, the mean ADC value of solid portions was 0.744 × 10−3 mm2/s, which was similar to a previous investigation of a C6 rat glioma-bearing model on an 11.7 tesla animal MR unit (18). In human glioblastoma, this value was reported to vary from 1.05-1.324 × 10−3 mm2/s (26-28), and the mean ADC value was obviously lower than that of human glioblastoma. The minimal ADC value of solid portions in this study was similar to that in a previous animal study on C6 rat glioma (29) and was still markedly lower than that value in human glioblastomas (in human glioblastomas, these values were reported to range from 0.673-0.934 × 10−3 mm2/s) (23,26,27,30).
Apparent Diffusion Coefficient Can Predict Response to Chemotherapy of Liver Metastases in Colorectal Cancer
2021, Academic RadiologyCitation Excerpt :Most reports in the literature concerning CRC metastases suggest that lower pretreatment ADC tumor values are associated with better treatment response (8,9). Comparable observations were made concerning glioblastoma, malignant astrocytoma and primary central nervous system lymphoma that a lower pretreatment ADC correlates with improved survival (37–39). Necrotic lesions with higher pretreatment ADC values generally appear less susceptible to chemotherapy (8,9,40,41).
A Phase 2 Study of Dose-intensified Chemoradiation Using Biologically Based Target Volume Definition in Patients With Newly Diagnosed Glioblastoma
2021, International Journal of Radiation Oncology Biology PhysicsUsefulness of Histogram-Profile Analysis in Ring-Enhancing Intracranial Lesions
2019, World NeurosurgeryCitation Excerpt :All MRI studies were performed in either a 1.5-T (Signa Horizon; GE Medical Systems; Wisconsin, Waukesha, USA; before July 2007) or a 3-T super conducting system (Signa Excite HD 3.0T; GE Medical Systems; after July 2007). MRI were obtained as described previously.18,19 To summarize in brief, for the 3-T system, MRI scans obtained included T2WI (repetition time [TR] 4800 milliseconds, echo time [TE] 100 milliseconds, echo train length 18, field of view 22 × 22 cm, matrix size 512 × 320, NEX 2, section thickness 6 mm, intersection gap 1.0 mm, 1 acquisition), axial spin-echo T1WI (TR 450 milliseconds, TE 18 milliseconds, field of view 18 × 18 cm, matrix size 288 × 192, section thickness 6 mm, intersection gap 1.0 mm, 2 acquisitions).
Preoperative imaging (MRI, functional MRI, CT)
2019, Comprehensive Overview of Modern Surgical Approaches to Intrinsic Brain TumorsProton Magnetic Resonance Spectroscopy Detection of High Lipid Levels and Low Apparent Diffusion Coefficient Is Characteristic of Germinomas
2018, World NeurosurgeryCitation Excerpt :The MRI studies were done in 3 orthogonal planes and included nonenhanced T1-weighted images, T2-weighted images, fluid-attenuated inversion recovery images, and T2*-weighted images as described previously.14,15 Pre-gadolinium (Gd) enhanced DWI was performed with b values of 1000 under the condition as explained in a previous study.14,15 Transverse, sagittal, and coronal spin-echo T1-weighted images were acquired after the intravenous administration of a Gd-based contrast medium.