title: Post-treatment changes of tumour perfusion parameters can help to predict survival in patients with high-grade astrocytoma.
abstract: OBJECTIVE
  Vascular characteristics of tumour and peritumoral volumes of high-grade gliomas change with treatment. This work evaluates the variations of T2*-weighted perfusion parameters as overall survival (OS) predictors.
  
  
  METHODS
  Forty-five patients with histologically confirmed high-grade astrocytoma (8 grade III and 37 grade IV) were included. All patients underwent pre- and post-treatment T2*-weighted contrast-enhanced magnetic resonance (MR) imaging. Tumour, peritumoral and control volumes were segmented. Relative variations of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), Ktrans-T2*, kep-T2*, ve-T2*and vp-T2*were calculated. Differences regarding tumour grade and surgical resection extension were evaluated with ANOVA tests. For each parameter, two groups were defined by non-supervised clusterisation. Survival analysis were performed on these groups.
  
  
  RESULTS
  For the tumour region, the 90th percentile increase or stagnation of CBV was associated with shorter survival, while a decrease related to longer survival (393 ± 189 vs 594 ± 294 days; log-rank p = 0.019; Cox hazard-ratio, 2.31; 95% confidence interval [CI], 1.12-4.74). Ktrans-T2*showed similar results (414 ± 177 vs 553 ± 312 days; log-rank p = 0.037; hazard-ratio, 2.19; 95% CI, 1.03-4.65). The peritumoral area values showed no relationship with OS.
  
  
  CONCLUSIONS
  Post-treatment variations of the highest CBV and Ktrans-T2*values in the tumour volume are predictive factors of OS in patients with high-grade gliomas.
  
  
  CONCLUSIONS
  • Vascular characteristics of high-grade glioma tumour and peritumoral regions change with treatment. • Quantitative assessment of MRI perfusion provides valuable information regarding tumour aggressiveness. • Quantitative T2*-weighted perfusion parameters can help to predict overall survival. • Post-treatment variations of CBV and Ktrans-T2values are predictive factors of OS. • Increased values may justify treatment intensification in these patients.
authors.affiliation: Radiology Department, Hospital Quirónsalud Valencia, Av Blasco Ibañez 14, 46010, Valencia, Spain. roberto.sanz@quironsalud.es.|Grupo de Investigación Biomédica en Imagen, Hospital Universitari i Politècnic La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain. roberto.sanz@quironsalud.es.
authors.forename: Roberto
authors.identifier: http://orcid.org/0000-0002-3659-1389
authors.initials: R
authors.lastname: Sanz-Requena
authors.affiliation: Radiology Department, Hospital de Manises, Av Generalitat Valenciana 50, 46940, Manises, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Revert-Ventura
authors.affiliation: Radiology Department, Hospital Quirónsalud Valencia, Av Blasco Ibañez 14, 46010, Valencia, Spain.|Grupo de Investigación Biomédica en Imagen, Hospital Universitari i Politècnic La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain.|CIBER-SAM, Instituto de Salud Carlos III, C Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Gracián
authors.initials: G
authors.lastname: García-Martí
authors.affiliation: Radiology Department, Hospital de Manises, Av Generalitat Valenciana 50, 46940, Manises, Spain.
authors.forename: Fares
authors.initials: F
authors.lastname: Salamé-Gamarra
authors.affiliation: Grupo de Investigación Biomédica en Imagen, Hospital Universitari i Politècnic La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pérez-Girbés
authors.affiliation: Radiology Department, Hospital La Ribera, Carretera de Corbera km 1, 46600, Alzira, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Mollá-Olmos
authors.affiliation: Radiology Department, Hospital Quirónsalud Valencia, Av Blasco Ibañez 14, 46010, Valencia, Spain.|Grupo de Investigación Biomédica en Imagen, Hospital Universitari i Politècnic La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martí-Bonmatí
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010477:Perfusion; D011379:Prognosis; D012189:Retrospective Studies
keywords: Brain; Neoplasms; Perfusion-weighted MRI; Quantitative evaluation; Survival