title: Intravoxel Incoherent Motion Metrics as Potential Biomarkers for Survival in Glioblastoma.
abstract: OBJECTIVE
  Intravoxel incoherent motion (IVIM) is an MRI technique with potential applications in measuring brain tumor perfusion, but its clinical impact remains to be determined. We assessed the usefulness of IVIM-metrics in predicting survival in newly diagnosed glioblastoma.
  
  
  METHODS
  Fifteen patients with glioblastoma underwent MRI including spin-echo echo-planar DWI using 13 b-values ranging from 0 to 1000 s/mm2. Parametric maps for diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were generated for contrast-enhancing regions (CER) and non-enhancing regions (NCER). Regions of interest were manually drawn in regions of maximum f and on the corresponding dynamic susceptibility contrast images. Prognostic factors were evaluated by Kaplan-Meier survival and Cox proportional hazards analyses.
  
  
  RESULTS
  We found that fCER and D*CER correlated with rCBFCER. The best cutoffs for 6-month survival were fCER>9.86% and D*CER>21.712 x10-3mm2/s (100% sensitivity, 71.4% specificity, 100% and 80% positive predictive values, and 80% and 100% negative predictive values; AUC:0.893 and 0.857, respectively). Treatment yielded the highest hazard ratio (5.484; 95% CI: 1.162-25.88; AUC: 0.723; P = 0.031); fCER combined with treatment predicted survival with 100% accuracy.
  
  
  CONCLUSIONS
  The IVIM-metrics fCER and D*CER are promising biomarkers of 6-month survival in newly diagnosed glioblastoma.
authors.affiliation: Imaging Research Unit, Institut de Diagnostic per la Imatge (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Puig
authors.affiliation: Philips Healthcare Ibérica, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sánchez-González
authors.affiliation: Imaging Research Unit, Institut de Diagnostic per la Imatge (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, 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: Pepus
authors.initials: P
authors.lastname: Daunis-I-Estadella
authors.affiliation: Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.|Department of Radiology, Neuroradiology Division, Stanford University, Palo Alto, United States of America.
authors.forename: Christian
authors.initials: C
authors.lastname: Federau
authors.affiliation: Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital, La Fe Health Research Institute, Valencia, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alberich-Bayarri
authors.affiliation: Imaging Research Unit, Institut de Diagnostic per la Imatge (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Biarnes
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, United States of America.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Nael
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 Langone Medical Center, New York, United States of America.
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University, Palo Alto, United States of America.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Imaging Research Unit, Institut de Diagnostic per la Imatge (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009038:Motion; D015588:Observer Variation; D010477:Perfusion; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers