title: Prognostic value of preoperative dynamic contrast-enhanced MRI perfusion parameters for high-grade glioma patients.
abstract: BACKGROUND
  The prognostic value of the dynamic contrast-enhanced (DCE) MRI perfusion and its histogram analysis-derived metrics is not well established for high-grade glioma (HGG) patients. The aim of this prospective study was to investigate DCE perfusion transfer coefficient (Ktrans), vascular plasma volume fraction (vp), extracellular volume fraction (ve), reverse transfer constant (kep), and initial area under gadolinium concentration time curve (IAUGC) as predictors of progression-free (PFS) and overall survival (OS) in HGG patients.
  
  
  METHODS
  Sixty-nine patients with suspected anaplastic astrocytoma or glioblastoma underwent preoperative DCE-MRI scans. DCE perfusion whole tumor region histogram parameters, clinical details, and PFS and OS data were obtained. Univariate, multivariate, and Kaplan-Meier survival analyses were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify perfusion parameters with the best differentiation performance.
  
  
  RESULTS
  On univariate analysis, veand skewness of vphad significant negative impacts, while kephad significant positive impact on OS (P < 0.05). vewas also a negative predictor of PFS (P < 0.05). Patients with lower veand IAUGC had longer median PFS and OS on Kaplan-Meier analysis (P < 0.05). Ktransand vecould also differentiate grade III from IV gliomas (area under the curve 0.819 and 0.791, respectively).
  
  
  CONCLUSIONS
  High veis a consistent predictor of worse PFS and OS in HGG glioma patients. vpskewness and kepare also predictive for OS. Ktransand vedemonstrated the best diagnostic performance for differentiating grade III from IV gliomas.
authors: Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors: Agne
authors: A
authors: Ulyte
authors: Department of Advanced Imaging Modalities - CT and MRI, General Anticancer and Oncological Hospital "St. Savvas", Athens, Greece.|Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece.
authors: Vasileios K
authors: VK
authors: Katsaros
authors: Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece.
authors: Evangelia
authors: E
authors: Liouta
authors: Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece.
authors: Georgios
authors: G
authors: Stranjalis
authors: Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece.|Department of Radiation Oncology, General Anticancer and Oncological Hospital "St. Savvas", Athens, Greece.
authors: Christos
authors: C
authors: Boskos
authors: Department of Radiology, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal.
authors: Nickolas
authors: N
authors: Papanikolaou
authors: National Cancer Institute, Vilnius, Lithuania.|Affidea Lietuva, Vilnius, Lithuania.
authors: Jurgita
authors: J
authors: Usinskiene
authors: Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Box 65, Queen Square 8-11, London, WC1N 3BG, UK. s.bisdas@uclh.nhs.uk.
authors: Sotirios
authors: http://orcid.org/0000-0001-9930-5549
authors: S
authors: Bisdas
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D060787:Neoplasm Grading; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Dynamic contrast-enhanced MRI; Gliomas; Perfusion transfer coefficient; Vascular plasma volume fraction