title: Glioblastoma: does the pre-treatment geometry matter? A postcontrast T1 MRI-based study.
abstract: BACKGROUND
  The potential of a tumour's volumetric measures obtained from pretreatment MRI sequences of glioblastoma (GBM) patients as predictors of clinical outcome has been controversial. Mathematical models of GBM growth have suggested a relation between a tumour's geometry and its aggressiveness.
  
  
  METHODS
  A multicenter retrospective clinical study was designed to study volumetric and geometrical measures on pretreatment postcontrast T1 MRIs of 117 GBM patients. Clinical variables were collected, tumours segmented, and measures computed including: contrast enhancing (CE), necrotic, and total volumes; maximal tumour diameter; equivalent spherical CE width and several geometric measures of the CE "rim". The significance of the measures was studied using proportional hazards analysis and Kaplan-Meier curves.
  
  
  RESULTS
  Kaplan-Meier and univariate Cox survival analysis showed that total volume [p = 0.034, Hazard ratio (HR) = 1.574], CE volume (p = 0.017, HR = 1.659), spherical rim width (p = 0.007, HR = 1.749), and geometric heterogeneity (p = 0.015, HR = 1.646) were significant parameters in terms of overall survival (OS). Multivariable Cox analysis for OS provided the later two parameters as age-adjusted predictors of OS (p = 0.043, HR = 1.536 and p = 0.032, HR = 1.570, respectively).
  
  
  CONCLUSIONS
  Patients with tumours having small geometric heterogeneity and/or spherical rim widths had significantly better prognosis. These novel imaging biomarkers have a strong individual and combined prognostic value for GBM patients.
  
  
  CONCLUSIONS
  • Three-dimensional segmentation on magnetic resonance images allows the study of geometric measures. • Patients with small width of contrast enhancing areas have better prognosis. • The irregularity of contrast enhancing areas predicts survival in glioblastoma patients.
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain. Julian.Perez@uclm.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Pérez-Beteta
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Martínez-González
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Molina
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Amo-Salas
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Luque
authors.affiliation: Hospital General de Ciudad Real, c/ Obispo Rafael Torija, Ciudad Real, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Arregui
authors.affiliation: Hospital General de Ciudad Real, c/ Obispo Rafael Torija, Ciudad Real, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Hospital General de Ciudad Real, c/ Obispo Rafael Torija, Ciudad Real, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Borrás
authors.affiliation: Hospital General de Ciudad Real, c/ Obispo Rafael Torija, Ciudad Real, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: López
authors.affiliation: Hospital General de Ciudad Real, c/ Obispo Rafael Torija, Ciudad Real, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Claramonte
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Barcia
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Iglesias
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Josué
authors.initials: J
authors.lastname: Avecillas
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Albillo
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Navarro
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Villanueva
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Paniagua
authors.affiliation: Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martino
authors.affiliation: Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Velásquez
authors.affiliation: Hospital Carlos Haya, Málaga, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Asenjo
authors.affiliation: Hospital Carlos Haya, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Benavides
authors.affiliation: Hospital Carlos Haya, Málaga, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Herruzo
authors.affiliation: Facultad de Matemáticas, Universidad de Sevilla, Sevilla, Spain.
authors.forename: María Del Carmen
authors.initials: MD
authors.lastname: Delgado
authors.affiliation: Facultad de Matemáticas, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Del Valle
authors.affiliation: Auckland Radiation Oncology, Auckland, New Zealand.
authors.forename: Anthony
authors.initials: A
authors.lastname: Falkov
authors.affiliation: Neurosurgery Department, Bern Inselspital, Bern, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.affiliation: Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Estanislao
authors.initials: E
authors.lastname: Arana
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Pérez-Romasanta
authors.affiliation: Laboratory of Mathematical Oncology, Edificio Politécnico, Instituto de Matemática Aplicada a la Ciencia y la Ingeniería, Universidad de Castilla-La Mancha, Avenida de Camilo José Cela, 3, 13071, Ciudad Real, Spain.
authors.forename: Víctor M
authors.initials: VM
authors.lastname: Pérez-García
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003287:Contrast Media; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden
chemical_list: D003287:Contrast Media
keywords: Contrast enhancement; GBM geometry; Glioblastoma; Mathematical model; Predictors of survival