MR Imaging Analysis of Non-Measurable Enhancing Lesions Newly Appearing after Concomitant Chemoradiotherapy in Glioblastoma Patients for Prognosis Prediction.
OBJECTIVE
To analyze the enhancement patterns and apparent diffusion coefficient (ADC) values of non-measurable surgical cavity wall enhancement pattern, newly appearing after completion of standard concurrent chemoradiotherapy (CCRT) with temozolomide in glioblastoma patients for the prognosis prediction.


METHODS
From January 2010 to April 2014, among 190 patients with histopathologically confirmed glioblastoma, a total of 33 patients with non-measurable wall enhancement on post-CCRT MR imaging were enrolled and divided into two subgroups: non-progression (n = 18) and progression groups (n = 15). We analyzed the wall enhancement patterns, which were categorized into three patterns: thin, thick and nodular enhancement. ADC values were measured in the enhancing portions of the walls. The progression-free survival (PFS) related to the wall enhancement was analyzed by Kaplan-Meier analysis, and survival curves were compared using the log-rank test.


RESULTS
Statistically significant differences in the surgical cavity wall enhancement patterns was shown between the progression and non-progression groups (P = 0.0032). Thin wall enhancement was more frequently observed in the non-progression group, and thick or nodular wall enhancement were observed in the progression group (P = 0.0016). There was no statistically significant difference in the mean ADC values between the progression and non-progression groups. The mean PFS was longer in patients with thin wall enhancement than in those with nodular or thick wall enhancement (35.5 months vs. 15.8 months, P = 0.008).


CONCLUSIONS
Pattern analysis of non-measurable surgical cavity wall enhancement on post-CCRT MR imaging might be useful tool for predicting prognosis of GBM patient before clear progression of non-measurable disease.
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Bo Ram
BR
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Seung Hong
http://orcid.org/0000-0002-5968-3884
SH
Choi
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Tae Jin
TJ
Yun
Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Soon-Tae
ST
Lee
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Chul-Kee
CK
Park
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Tae Min
TM
Kim
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Ji-Hoon
JH
Kim
Department of Radiology, Boramae Medical Center, Seoul, Republic of Korea.
Sun-Won
SW
Park
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Chul-Ho
CH
Sohn
Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
Sung-Hye
SH
Park
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
Il Han
IH
Kim
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D000077204:Temozolomide; D055815:Young Adult
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide