title: Survival analysis in patients with glioblastoma multiforme: predictive value of choline-to-N-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume.
abstract: OBJECTIVE
  To investigate the potential value of pre-external-beam radiation therapy (XRT) choline-to-NAA (N-acetylaspartate) index (CNI), apparent diffusion coefficient (ADC), and relative cerebral blood volume (rCBV) for predicting survival in newly diagnosed patients with glioblastoma multiforme (GBM).
  
  
  METHODS
  Twenty-eight patients with GBM were studied using in vivo proton magnetic resonance spectroscopic imaging (1H MRSI) and diffusion- and perfusion-weighted imaging after surgery but prior to XRT. Patients were categorized on the basis of their volumes of morphologic and metabolic abnormalities (volume of CNI > or = 2 and CNI values), normalized ADC (nADC), or rCBV values within the T1 contrast-enhancing and T2 regions. The median survival time was compared.
  
  
  RESULTS
  A significantly shorter median survival time was observed for patients with a large volume of metabolic abnormality than for those with a small abnormality (12.0 and 17.1 months, respectively, P = 0.002). A similar pattern was observed for patients with a low mean nADC value compared to those with high mean nADC value within the T2 region (11.2 and 21.7 months, respectively, P = 0.004). A shorter median survival time was also observed for patients with contrast-enhancing residual disease than for those without the presence of contrast enhancement with marginal significance.
  
  
  CONCLUSIONS
  The pre-XRT volume of the metabolic abnormality and the nADC value within the T2 region may be valuable in predicting outcome for patients with GBM.
authors.affiliation: Magnetic Resonance Science Center, Department of Radiology, University of California, San Francisco, California 94107, USA. joonmi@mrsc.ucsf.edu
authors.forename: Joonmi
authors.initials: J
authors.lastname: Oh
authors.forename: Roland G
authors.initials: RG
authors.lastname: Henry
authors.forename: Andrea
authors.initials: A
authors.lastname: Pirzkall
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Li
authors.forename: Isabelle
authors.initials: I
authors.lastname: Catalaa
authors.forename: Susan
authors.initials: S
authors.lastname: Chang
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001810:Blood Volume; D001932:Brain Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000503:physiopathology / Q000532:radiotherapy; D002794:Choline / Q000378:metabolism; D005909:Glioblastoma / Q000378:metabolism* / Q000401:mortality* / Q000503:physiopathology / Q000532:radiotherapy; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011522:Protons; D016019:Survival Analysis
chemical_list: D011522:Protons; D001224:Aspartic Acid; C000179:N-acetylaspartate; D002794:Choline