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Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival

Li, C; Yan, JL; Torheim, T; McLean, MA; Boonzaier, NR; Zou, J; Huang, Y; ... Price, SJ; + view all (2019) Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival. Radiotherapy and Oncology , 134 pp. 17-24. 10.1016/j.radonc.2019.01.008. Green open access

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Abstract

Background and purpose: Glioblastoma exhibits profound intratumoral heterogeneity in perfusion. Particularly, low perfusion may induce treatment resistance. Thus, imaging approaches that define low perfusion compartments are crucial for clinical management. Materials and methods: A total of 112 newly diagnosed glioblastoma patients were prospectively recruited for maximal safe resection. The apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) were calculated from diffusion and perfusion imaging, respectively. Based on the overlapping regions of lowest rCBV quartile (rCBV L ) with the lowest ADC quartile (ADC L ) and highest ADC quartile (ADC H ) in each tumor, two low perfusion compartments (ADC H -rCBV L and ADC L -rCBV L ) were identified for volumetric analysis. Lactate and macromolecule/lipid levels were determined from multivoxel MR spectroscopic imaging. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier's and multivariate Cox regression analyses, to evaluate the effects of compartment volume and lactate level on survival. Results: Two compartments displayed higher lactate and macromolecule/lipid levels compared to contralateral normal-appearing white matter (each P < 0.001). The proportion of the ADC L -rCBV L compartment in the contrast-enhancing tumor was associated with a larger infiltration on FLAIR (P < 0.001, rho = 0.42). The minimally invasive phenotype displayed a lower proportion of the ADC L -rCBV L compartment than the localized (P = 0.031) and diffuse phenotypes (not significant). Multivariate Cox regression showed higher lactate level in the ADC L -rCBV L compartment was associated with worsened survival (PFS: HR 2.995, P = 0.047; OS: HR 4.974, P = 0.005). Conclusions: Our results suggest that the ADC L -rCBV L compartment may potentially indicate a clinically measurable resistant compartment.

Type: Article
Title: Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.radonc.2019.01.008
Publisher version: https://doi.org/10.1016/j.radonc.2019.01.008
Language: English
Additional information: Copyright © 2019 Elsevier B.V. All rights reserved. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http:// www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed.
Keywords: Glioblastoma, Tumor habitat imaging, Heterogeneity, Radioresistance, Perfusion imaging, Diffusion imaging
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Developmental Neurosciences Prog
URI: http://discovery.ucl.ac.uk/id/eprint/10071149
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