A prognostic model based on preoperative MRI predicts overall survival in patients with diffuse gliomas.
OBJECTIVE
Diffuse gliomas are classified as grades II-IV on the basis of histologic features, with prognosis determined mainly by clinical factors and histologic grade supported by molecular markers. Our aim was to evaluate, in patients with diffuse gliomas, the relationship of relative CBV and ADC values to overall survival. In addition, we also propose a prognostic model based on preoperative MR imaging findings that predicts survival independent of histopathology.


METHODS
We conducted a retrospective analysis of the preoperative diffusion and perfusion MR imaging in 126 histologically confirmed diffuse gliomas. Median relative CBV and ADC values were selected for quantitative analysis. Survival univariate analysis was made by constructing survival curves by using the Kaplan-Meier method and comparing subgroups by log-rank probability tests. A Cox regression model was made for multivariate analysis.


RESULTS
The study included 126 diffuse gliomas (median follow-up of 14.5 months). ADC and relative CBV values had a significant influence on overall survival. Median overall survival for patients with ADC < 0.799 × 10(-3) mm(2)/s was <1 year. Multivariate analysis revealed that patient age, relative CBV, and ADC values were associated with survival independent of pathology. The preoperative model provides greater ability to predict survival than that obtained by histologic grade alone.


CONCLUSIONS
ADC values had a better correlation with overall survival than relative CBV values. A preoperative prognostic model based on patient age, relative CBV, and ADC values predicted overall survival of patients with diffuse gliomas independent of pathology. This preoperative model provides a more accurate predictor of survival than histologic grade alone.
From the Departments of Radiology (A.H., A.R., E.S., J.M.M.) amayahilario@yahoo.es.
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A
Hilario
Medical Oncology (J.M.S.).
J M
JM
Sepulveda
Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain.
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A
Perez-Nuñez
From the Departments of Radiology (A.H., A.R., E.S., J.M.M.).
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E
Salvador
From the Departments of Radiology (A.H., A.R., E.S., J.M.M.).
J M
JM
Millan
Neuropathology (A.H.-L.).
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A
Hernandez-Lain
Radiation Oncology (V.R.-G.).
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Rodriguez-Gonzalez
Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain.
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A
Lagares
From the Departments of Radiology (A.H., A.R., E.S., J.M.M.).
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A
Ramos
D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D066230:Patient-Specific Modeling / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate