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

Chao Li; Jiun Lin Yan; Turid Torheim; Mary A. McLean; Natalie R. Boonzaier; Jingjing Zou; Yuan Huang; Jianmin Yuan; Bart R.J. van Dijken; Tomasz Matys; Florian Markowetz; Stephen J. Price

doi:10.1016/j.radonc.2019.01.008

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

Chao Li^*, Jiun Lin Yan, Turid Torheim, Mary A. McLean, Natalie R. Boonzaier, Jingjing Zou, Yuan Huang, Jianmin Yuan, Bart R.J. van Dijken, Tomasz Matys, Florian Markowetz, Stephen J. Price

^*此作品的通信作者

中醫學系(含學士班、天然藥物、傳統中醫藥碩士班)

研究成果: 期刊稿件 › 文章 › 同行評審

19 引文斯高帕斯（Scopus）

摘要

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.

原文	英語
頁（從 - 到）	17-24
頁數	8
期刊	Radiotherapy and Oncology
卷	134
DOIs	https://doi.org/10.1016/j.radonc.2019.01.008
出版狀態	已出版 - 05 2019

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© 2019 Elsevier B.V.

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10.1016/j.radonc.2019.01.008

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Li, C., Yan, J. L., Torheim, T., McLean, M. A., Boonzaier, N. R., Zou, J., Huang, Y., Yuan, J., van Dijken, B. R. J., Matys, T., Markowetz, F., & Price, S. J. (2019). Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival. Radiotherapy and Oncology, 134, 17-24. https://doi.org/10.1016/j.radonc.2019.01.008

@article{9cb356d8c83b4728a3a923eb45275b38,

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

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.",

keywords = "Diffusion imaging, Glioblastoma, Heterogeneity, Perfusion imaging, Radioresistance, Tumor habitat imaging",

author = "Chao Li and Yan, {Jiun Lin} and Turid Torheim and McLean, {Mary A.} and Boonzaier, {Natalie R.} and Jingjing Zou and Yuan Huang and Jianmin Yuan and {van Dijken}, {Bart R.J.} and Tomasz Matys and Florian Markowetz and Price, {Stephen J.}",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = may,

doi = "10.1016/j.radonc.2019.01.008",

language = "英语",

volume = "134",

pages = "17--24",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Low perfusion compartments in glioblastoma quantified by advanced magnetic resonance imaging and correlated with patient survival

AU - Li, Chao

AU - Yan, Jiun Lin

AU - Torheim, Turid

AU - McLean, Mary A.

AU - Boonzaier, Natalie R.

AU - Zou, Jingjing

AU - Huang, Yuan

AU - Yuan, Jianmin

AU - van Dijken, Bart R.J.

AU - Matys, Tomasz

AU - Markowetz, Florian

AU - Price, Stephen J.

PY - 2019/5

Y1 - 2019/5

N2 - 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.

AB - 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.

KW - Diffusion imaging

KW - Glioblastoma

KW - Heterogeneity

KW - Perfusion imaging

KW - Radioresistance

KW - Tumor habitat imaging

UR - http://www.scopus.com/inward/record.url?scp=85060758871&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2019.01.008

DO - 10.1016/j.radonc.2019.01.008

M3 - 文章

C2 - 31005212

AN - SCOPUS:85060758871

SN - 0167-8140

VL - 134

SP - 17

EP - 24

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

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

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