The Added Prognostic Value of Preoperative Dynamic Contrast-Enhanced MRI Histogram Analysis in Patients with Glioblastoma: Analysis of Overall and Progression-Free Survival.
OBJECTIVE
The prognostic value of dynamic contrast-enhanced MR imaging in patients with glioblastoma is controversial. We investigated the added prognostic value of dynamic contrast-enhanced MR imaging to clinical parameters and molecular biomarkers in patients with glioblastoma by using histogram analysis.


METHODS
This retrospective study consisted of 61 patients who underwent preoperative dynamic contrast-enhanced MR imaging for glioblastoma. The histogram parameters of dynamic contrast-enhanced MR imaging, including volume transfer constant, extravascular extracellular volume fraction, and plasma volume fraction, were calculated from entire enhancing tumors. Univariate analyses for overall survival and progression-free survival were performed with preoperative clinical and dynamic contrast-enhanced MR imaging parameters and postoperative molecular biomarkers. Multivariate Cox regression was performed to build pre- and postoperative models for overall survival and progression-free survival. The performance of models was assessed by calculating the Harrell concordance index.


RESULTS
In univariate analysis, patients with higher volume transfer constant and extravascular extracellular volume fraction values showed worse overall survival and progression-free survival, whereas plasma volume fraction showed no significant correlation. In multivariate analyses for overall survival, the fifth percentile value of volume transfer constant and kurtosis of extravascular extracellular volume fraction were independently prognostic in the preoperative model, and kurtosis of volume transfer constant and extravascular extracellular volume fraction were independently prognostic in the postoperative model. For progression-free survival, independent prognostic factors were minimum and fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction in the preoperative model and kurtosis of extravascular extracellular volume fraction in the postoperative model. The performance of preoperative models for progression-free survival was significantly improved when minimum or fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction were added.


CONCLUSIONS
Higher volume transfer constant and extravascular extracellular volume fraction values are associated with worse prognosis, and dynamic contrast-enhanced MR imaging may have added prognostic value in combination with preoperative clinical parameters, especially in predicting progression-free survival.
From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.).
Y S
http://orcid.org/0000-0002-6034-9912
YS
Choi
Department of Policy Research Affairs (D.W.K.), National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea.
D W
DW
Kim
From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.).
S-K
SK
Lee
Neurosurgery (J.H.C., S.-G.K., E.H.K.).
J H
JH
Chang
Neurosurgery (J.H.C., S.-G.K., E.H.K.).
S-G
SG
Kang
Neurosurgery (J.H.C., S.-G.K., E.H.K.).
E H
EH
Kim
Pathology (S.H.K.).
S H
SH
Kim
Ophthalmology (T.H.R.), Yonsei University College of Medicine, Seoul, Korea.
T H
TH
Rim
From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.) SUNGSOO@yuhs.ac.
S S
SS
Ahn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology*; D003287:Contrast Media; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D003287:Contrast Media