Characterizing tumor invasiveness of glioblastoma using multiparametric magnetic resonance imaging

Chao Li*, Shuo Wang, Jiun Lin Yan, Turid Torheim, Natalie R. Boonzaier, Rohitashwa Sinha, Tomasz Matys, Florian Markowetz, Stephen J. Price

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

33 Scopus citations

Abstract

OBJECTIVE The objective of this study was to characterize the abnormalities revealed by diffusion tensor imaging (DTI) using MR spectroscopy (MRS) and perfusion imaging, and to evaluate the prognostic value of a proposed quantitative measure of tumor invasiveness by combining contrast-enhancing (CE) and DTI abnormalities in patients with glioblastoma. METHODS Eighty-four patients with glioblastoma were recruited preoperatively. DTI was decomposed into isotropic (p) and anisotropic (q) components. The relative cerebral blood volume (rCBV) was calculated from the dynamic susceptibility contrast imaging. Values of N-acetylaspartate, myoinositol, choline (Cho), lactate (Lac), and glutamate + glutamine (Glx) were measured from multivoxel MRS and normalized as ratios to creatine (Cr). Tumor regions of interest (ROIs) were manually segmented from the CE T1-weighted (CE-ROI) and DTI-q (q-ROI) maps. Perfusion and metabolic characteristics of these ROIs were measured and compared. The relative invasiveness coefficient (RIC) was calculated as a ratio of the characteristic radii of CE-ROI and q-ROI. The prognostic significance of RIC was tested using Kaplan-Meier and multivariate Cox regression analyses. RESULTS The Cho/Cr, Lac/Cr, and Glx/Cr in q-ROI were significantly higher than CE-ROI (p = 0.004, p = 0.005, and p = 0.007, respectively). CE-ROI had significantly higher rCBV values than q-ROI (p < 0.001). A higher RIC was associated with worse survival in a multivariate overall survival (OS) model (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.06–1.85, p = 0.016) and progression-free survival (PFS) model (HR 1.55, 95% CI 1.16–2.07, p = 0.003). An RIC cutoff value of 0.89 significantly predicted shorter OS (median 384 vs 605 days, p = 0.002) and PFS (median 244 vs 406 days, p = 0.001). CONCLUSIONS DTI-q abnormalities displayed higher tumor load and hypoxic signatures compared with CE abnormalities, whereas CE regions potentially represented the tumor proliferation edge. Integrating the extents of invasion visualized by DTI-q and CE images into clinical practice may lead to improved treatment efficacy.

Original languageEnglish
Pages (from-to)1465-1472
Number of pages8
JournalJournal of Neurosurgery
Volume132
Issue number5
DOIs
StatePublished - 05 2020

Bibliographical note

Publisher Copyright:
© AANS 2020, except where prohibited by US copyright law.

Keywords

  • Diffusion tensor imaging
  • Glioblastoma
  • MRI
  • Magnetic resonance spectroscopy
  • Oncology
  • Perfusion imaging
  • Prognosis

Fingerprint

Dive into the research topics of 'Characterizing tumor invasiveness of glioblastoma using multiparametric magnetic resonance imaging'. Together they form a unique fingerprint.

Cite this