title: Prognostic vascular imaging biomarkers in high-grade gliomas: tumor permeability as an adjunct to blood volume estimates.
abstract: OBJECTIVE
  Despite recent advances in the treatment of high-grade gliomas, overall survival (OS) remains poor, which underlines the importance of searching for and determining prognostic imaging biomarkers. The purpose of our retrospective study was to correlate patient survival with relative cerebral blood volume (rCBV) and permeability surface area-product (PS) measured using perfusion computed tomography (PCT) in patients with high-grade gliomas.
  
  
  METHODS
  This study was composed of 54 patients with high-grade gliomas (World Health Organization [WHO] grade III, n = 14; WHO grade IV, n = 40) who underwent pretreatment PCT. Kaplan-Meier survival estimates were computed to describe OS for patients with high-versus-low PCT parameters, as well as grade III and IV gliomas.
  
  
  RESULTS
  Differences in OS between high and low rCBV, PS, and rCBV + PS were significant (P < .001) for all high-grade gliomas. After adjustment for WHO grade, rCBV (P = .041) and rCBV + PS (P = .013) estimates remained significant, whereas PS estimates were not (P = .214). PS estimates showed a statistically significant difference for OS in the grade III glioma group (P = .011), whereas for grade IV gliomas, rCBV estimates were statistically significant (P = .019). rCBV + PS was statistically significant for OS in both grade III (P = .001) and grade IV (P = .004) glioma groups.
  
  
  CONCLUSIONS
  Blood volume and permeability estimates measured using PCT can help predict survival in patients with high-grade gliomas. Patients with high PCT parameters showed worse OS compared to the patients with low PCT. Both rCBV and rCBV + PS remained statistically significant even after adjustment for WHO grade, suggesting these may be better predictors of OS than histological grade.
authors.affiliation: Department of Radiology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA. rajanj@rad.hfh.edu
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.forename: Jayant
authors.initials: J
authors.lastname: Narang
authors.forename: Brent
authors.initials: B
authors.lastname: Griffith
authors.forename: Hassan
authors.initials: H
authors.lastname: Bagher-Ebadian
authors.forename: Lisa
authors.initials: L
authors.lastname: Scarpace
authors.forename: Tom
authors.initials: T
authors.lastname: Mikkelsen
authors.forename: Benjamin
authors.initials: B
authors.lastname: Littenberg
authors.forename: Lonni R
authors.initials: LR
authors.lastname: Schultz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D001932:Brain Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D002199:Capillary Permeability; D002560:Cerebrovascular Circulation; D005260:Female; D005910:Glioma / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult