Abstract
OBJECTIVE: To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas (LGGs) and thus provide a second reference standard in the surgical and postsurgical management of LGGs. METHODS: Thirty-five patients with histologically diagnosed LGGs (21 low-grade astrocytomas and 14 low-grade oligodendrogliomas and low-grade mixed oligoastrocytomas) were studied with dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging. Wilcoxon tests were used to compare patients in different response categories (complete response, stable, progressive, death) with respect to baseline rCBV. Log-rank tests were used to evaluate the association of rCBV with survival and time to progression. Kaplan-Meier time-to-progression curves were generated. Tumor volumes and CBV measurements were obtained at the initial examination and again at follow-up to determine the association of rCBV with tumor volume progression. RESULTS: Wilcoxon tests showed patients manifesting an adverse event (either death or progression) had significantly higher rCBV (P = 0.003) than did patients without adverse events (complete response or stable disease). Log-rank tests showed that rCBV exhibited a significant negative association with disease-free survival (P = 0.0015), such that low rCBV values were associated with longer time to progression. Kaplan-Meier curves demonstrated that lesions with rCBV less than 1.75 (n = 16) had a median time to progression of 4620 ± 433 days, and lesions with rCBV more than 1.75 (n = 19) had a median time to progression of 245 ± 62 days (P < 0.005). Lesions with low baseline rCBV (<1.75) demonstrated stable tumor volumes when followed up over time, and lesions with high baseline rCBV (>1.75) demonstrated progressively increasing tumor volumes over time. CONCLUSION: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging may be used to identify LGGs that are either high-grade gliomas, misdiagnosed because of sampling error at pathological examination or that have undergone angiogenesis in the progression toward malignant transformation. This suggests that rCBV measurements may be used as a second reference standard to determine the surgical management/risk - benefit equation and postsurgical adjuvant therapy for LGGs.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1099-1107 |
| Number of pages | 9 |
| Journal | Neurosurgery |
| Volume | 58 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2006 |
| Externally published | Yes |
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Keywords
- Brain
- Low-grade gliomas
- Perfusion magnetic resonance imaging
- Survival
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology : A second reference standard in the surgical and nonsurgical treatment of low-grade gliomas. / Law, Meng; Oh, Sarah K.; Johnson, Glyn; Babb, James S.; Zagzag, David; Golfinos, John; Kelly, Patrick J.
In: Neurosurgery, Vol. 58, No. 6, 06.2006, p. 1099-1107.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology
T2 - A second reference standard in the surgical and nonsurgical treatment of low-grade gliomas
AU - Law, Meng
AU - Oh, Sarah K.
AU - Johnson, Glyn
AU - Babb, James S.
AU - Zagzag, David
AU - Golfinos, John
AU - Kelly, Patrick J.
PY - 2006/6
Y1 - 2006/6
N2 - OBJECTIVE: To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas (LGGs) and thus provide a second reference standard in the surgical and postsurgical management of LGGs. METHODS: Thirty-five patients with histologically diagnosed LGGs (21 low-grade astrocytomas and 14 low-grade oligodendrogliomas and low-grade mixed oligoastrocytomas) were studied with dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging. Wilcoxon tests were used to compare patients in different response categories (complete response, stable, progressive, death) with respect to baseline rCBV. Log-rank tests were used to evaluate the association of rCBV with survival and time to progression. Kaplan-Meier time-to-progression curves were generated. Tumor volumes and CBV measurements were obtained at the initial examination and again at follow-up to determine the association of rCBV with tumor volume progression. RESULTS: Wilcoxon tests showed patients manifesting an adverse event (either death or progression) had significantly higher rCBV (P = 0.003) than did patients without adverse events (complete response or stable disease). Log-rank tests showed that rCBV exhibited a significant negative association with disease-free survival (P = 0.0015), such that low rCBV values were associated with longer time to progression. Kaplan-Meier curves demonstrated that lesions with rCBV less than 1.75 (n = 16) had a median time to progression of 4620 ± 433 days, and lesions with rCBV more than 1.75 (n = 19) had a median time to progression of 245 ± 62 days (P < 0.005). Lesions with low baseline rCBV (<1.75) demonstrated stable tumor volumes when followed up over time, and lesions with high baseline rCBV (>1.75) demonstrated progressively increasing tumor volumes over time. CONCLUSION: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging may be used to identify LGGs that are either high-grade gliomas, misdiagnosed because of sampling error at pathological examination or that have undergone angiogenesis in the progression toward malignant transformation. This suggests that rCBV measurements may be used as a second reference standard to determine the surgical management/risk - benefit equation and postsurgical adjuvant therapy for LGGs.
AB - OBJECTIVE: To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas (LGGs) and thus provide a second reference standard in the surgical and postsurgical management of LGGs. METHODS: Thirty-five patients with histologically diagnosed LGGs (21 low-grade astrocytomas and 14 low-grade oligodendrogliomas and low-grade mixed oligoastrocytomas) were studied with dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging. Wilcoxon tests were used to compare patients in different response categories (complete response, stable, progressive, death) with respect to baseline rCBV. Log-rank tests were used to evaluate the association of rCBV with survival and time to progression. Kaplan-Meier time-to-progression curves were generated. Tumor volumes and CBV measurements were obtained at the initial examination and again at follow-up to determine the association of rCBV with tumor volume progression. RESULTS: Wilcoxon tests showed patients manifesting an adverse event (either death or progression) had significantly higher rCBV (P = 0.003) than did patients without adverse events (complete response or stable disease). Log-rank tests showed that rCBV exhibited a significant negative association with disease-free survival (P = 0.0015), such that low rCBV values were associated with longer time to progression. Kaplan-Meier curves demonstrated that lesions with rCBV less than 1.75 (n = 16) had a median time to progression of 4620 ± 433 days, and lesions with rCBV more than 1.75 (n = 19) had a median time to progression of 245 ± 62 days (P < 0.005). Lesions with low baseline rCBV (<1.75) demonstrated stable tumor volumes when followed up over time, and lesions with high baseline rCBV (>1.75) demonstrated progressively increasing tumor volumes over time. CONCLUSION: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging may be used to identify LGGs that are either high-grade gliomas, misdiagnosed because of sampling error at pathological examination or that have undergone angiogenesis in the progression toward malignant transformation. This suggests that rCBV measurements may be used as a second reference standard to determine the surgical management/risk - benefit equation and postsurgical adjuvant therapy for LGGs.
KW - Brain
KW - Low-grade gliomas
KW - Perfusion magnetic resonance imaging
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=33745114332&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33745114332&partnerID=8YFLogxK
U2 - 10.1227/01.NEU.0000215944.81730.18
DO - 10.1227/01.NEU.0000215944.81730.18
M3 - Article
VL - 58
SP - 1099
EP - 1107
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -