Perfusion and diffusion MRI of glioblastoma progression in a four-year prospective temozolomide clinical trial.
OBJECTIVE
This study was performed to determine the impact of perfusion and diffusion magnetic resonance imaging (MRI) sequences on patients during treatment of newly diagnosed glioblastoma. Special emphasis has been given to these imaging technologies as tools to potentially anticipate disease progression, as progression-free survival is frequently used as a surrogate endpoint.


METHODS
Forty-one patients from a phase II temolozomide clinical trial were included. During follow-up, images were integrated 21 to 28 days after radiochemotherapy and every 2 months thereafter. Assessment of scans included measurement of size of lesion on T1 contrast-enhanced, T2, diffusion, and perfusion images, as well as mass effect. Classical criteria on tumor size variation and clinical parameters were used to set disease progression date.


RESULTS
A total of 311 MRI examinations were reviewed. At disease progression (32 patients), a multivariate Cox regression determined 2 significant survival parameters: T1 largest diameter (p < 0.02) and T2 size variation (p < 0.05), whereas perfusion and diffusion were not significant.


CONCLUSIONS
Perfusion and diffusion techniques cannot be used to anticipate tumor progression. Decision making at disease progression is critical, and classical T1 and T2 imaging remain the gold standard. Specifically, a T1 contrast enhancement over 3 cm in largest diameter together with an increased T2 hypersignal is a marker of inferior prognosis.
Leimgruber
Antoine
A
Department of Radiology, Lausanne State and University Hospital, Lausanne, Switzerland.
Ostermann
Sandrine
S
Yeon
Eun Jo
EJ
Buff
Evelyn
E
Maeder
Philippe P
PP
Stupp
Roger
R
Meuli
Reto A
RA
D000704:Analysis of Variance; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077204:Temozolomide
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide