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Published on: May 30, 2011
Arterial spin-labeling perfusion MRI stratifies progression-free survival and correlates with epidermal growth factor
X J Qiao1, B M Ellingson1, H J Kim1
1From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.).
Background And Purpose:
Glioblastoma is a common primary brain tumor with a poor but variable prognosis. Our aim was to investigate the feasibility of MR perfusion imaging by using arterial spin-labeling for determining the prognosis of patients with glioblastoma.
Materials And Methods:
Pseudocontinuous arterial spin-labeling with 3D background-suppressed gradient and spin-echo was acquired before surgery on 53 patients subsequently diagnosed with glioblastoma. The calculated CBF color maps were visually evaluated by 3 independent readers blinded to patient history. Pathologic and survival data were correlated with CBF map findings. Arterial spin-labeling values in tumor tissue were also quantified by using manual fixed-size ROIs.
Results:
Two perfusion patterns were characterized by visual evaluation of CBF maps on the basis of either the presence (pattern 1) or absence (pattern 2) of substantial hyperperfused tumor tissue. Evaluation of the perfusion patterns was highly concordant among the 3 readers (κ = 0.898, P < .001). Pattern 1 (versus pattern 2) was associated with significantly shorter progression-free survival by Kaplan-Meier analysis (median progression-free survival of 182 days versus 485 days, P < .01) and trended with shorter overall survival (P = .079). There was a significant association between pattern 1 and epidermal growth factor receptor variant III expression (P < .01).
Conclusions:
Qualitative evaluation of arterial spin-labeling CBF maps can be used to stratify survival and predict epidermal growth factor receptor variant III expression in patients with glioblastoma.
Insights
Arterial spin-labeling MR perfusion imaging can predict glioblastoma prognosis. Visualizing tumor blood flow patterns helps determine patient survival and epidermal growth factor receptor variant III expression.
Area of Science:
- Neuroimaging
- Oncology
- Radiology
Background:
- Glioblastoma is an aggressive primary brain tumor with variable patient prognosis.
- Accurate prognostic markers are crucial for guiding treatment decisions.
- MR perfusion imaging offers potential for non-invasive prognostic assessment.
Purpose of the Study:
- To investigate the feasibility of MR perfusion imaging using arterial spin-labeling (ASL) for glioblastoma prognosis.
- To correlate ASL-derived cerebral blood flow (CBF) patterns with patient survival outcomes.
- To assess the association between ASL findings and specific molecular markers like EGFRvIII.
Main Methods:
- Pseudocontinuous ASL with 3D background-suppressed gradient and spin-echo MRI was performed on 53 glioblastoma patients pre-surgery.
- Cerebral blood flow (CBF) color maps were qualitatively evaluated by three blinded readers.
- Survival data and pathological findings were correlated with visual perfusion patterns and quantified ASL values.
Main Results:
- Two distinct ASL CBF perfusion patterns were identified: substantial hyperperfusion (pattern 1) and absence of substantial hyperperfusion (pattern 2).
- Visual evaluation of perfusion patterns showed high inter-reader concordance (κ = 0.898).
- Pattern 1 was significantly associated with shorter progression-free survival (182 vs. 485 days) and predicted EGFRvIII expression.
Conclusions:
- Qualitative assessment of ASL CBF maps provides a feasible method for glioblastoma prognosis.
- ASL imaging can stratify patient survival and predict EGFRvIII expression.
- This non-invasive technique aids in personalized treatment strategies for glioblastoma.
