title: High-resolution blood-pool-contrast-enhanced MR angiography in glioblastoma: tumor-associated neovascularization as a biomarker for patient survival. A preliminary study.
abstract: BACKGROUND
  The objective of the study was to determine whether tumor-associated neovascularization on high-resolution gadofosveset-enhanced magnetic resonance angiography (MRA) is a useful biomarker for predicting survival in patients with newly diagnosed glioblastomas.
  
  
  METHODS
  Before treatment, 35 patients (25 men; mean age, 64 ± 14 years) with glioblastoma underwent MRI including first-pass dynamic susceptibility contrast (DSC) perfusion and post-contrast T1WI sequences with gadobutrol (0.1 mmol/kg) and, 48 h later, high-resolution MRA with gadofosveset (0.03 mmol/kg). Volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter were obtained, and DSC perfusion and DWI parameters were evaluated. Prognostic factors were assessed by Kaplan-Meier survival and Cox proportional hazards model.
  
  
  RESULTS
  Eighteen (51.42 %) glioblastomas were hypervascular on high-resolution MRA. Hypervascular glioblastomas were associated with higher CEL volume and lower Karnofsky score. Median survival rates for patients with hypovascular and hypervascular glioblastomas treated with surgery, radiotherapy, and chemotherapy were 15 and 9.75 months, respectively (P < 0.001). Tumor-associated neovascularization was the best predictor of survival at 5.25 months (AUC = 0.794, 81.2 % sensitivity, 77.8 % specificity, 76.5 % positive predictive value, 82.4 % negative predictive value) and yielded the highest hazard ratio (P < 0.001).
  
  
  CONCLUSIONS
  Tumor-associated neovascularization detected on high-resolution blood-pool-contrast-enhanced MRA of newly diagnosed glioblastoma seems to be a useful biomarker that correlates with worse survival.
authors.affiliation: Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain. jpuigalcantara@idibgi.org.
authors.forename: Josep
authors.initials: J
authors.lastname: Puig
authors.affiliation: Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Blasco
authors.affiliation: Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Daunis-I-Estadella
authors.affiliation: Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, La Fe Polytechnics and University Hospital, Valencia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Alberich-Bayarri
authors.affiliation: Department of Radiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
authors.affiliation: Division of Neuroradiology, Department of Radiology, NYU School of Medicine, New York, NY, USA.
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.affiliation: Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Remollo
authors.affiliation: Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Hernández
authors.affiliation: Catalan Institute of Oncology (ICO), Hospital Cancer Registry, Hospital Universitari Dr Josep Trueta, Girona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Puigdemont
authors.affiliation: Philips Healthcare Ibérica, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sánchez-González
authors.affiliation: Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Mateu
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University, Palo Alto, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGI, Hospital Universitari Dr Josep Trueta, Av de Francia s/n, 17007, Girona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
mesh_terms: D015415:Biomarkers; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D005682:Gadolinium; D005909:Glioblastoma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D009942:Organometallic Compounds; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium
keywords: Angiography; Brain neoplasms; Glioblastoma; Magnetic resonance imaging; Survival