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Volumetric assessment of glioblastoma and its predictive value for survival

BackgroundThe objective of this study was to evaluate the morphology of glioblastoma on structural pretreatment magnetic resonance imaging (MRI), defining imaging prognostic factors.MethodWe conducted a retrospective analysis of MR images from 114 patients harboring a primary glioblastoma, derived f...

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Main Authors: Henker, Christian (Author) , Hiepel, Marie Cristin (Author) , Kriesen, Thomas (Author) , Scherer, Moritz (Author) , Glass, Änne (Author) , Herold-Mende, Christel (Author) , Bendszus, Martin (Author) , Langner, Sönke (Author) , Weber, Marc-André (Author) , Schneider, Björn (Author) , Unterberg, Andreas (Author) , Piek, Jürgen (Author)
Format: Article (Journal)
Language:English
Published: 28 June 2019
In: Acta neurochirurgica
Year: 2019, Volume: 161, Issue: 8, Pages: 1723-1732
ISSN:0942-0940
DOI:10.1007/s00701-019-03966-6
Online Access:Verlag, Volltext: https://doi.org/10.1007/s00701-019-03966-6
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Author Notes:Christian Henker, Marie Cristin Hiepel, Thomas Kriesen, Moritz Scherer, Änne Glass, Christel Herold-Mende, Martin Bendszus, Sönke Langner, Marc-André Weber, Björn Schneider, Andreas Unterberg, Jürgen Piek
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Summary:BackgroundThe objective of this study was to evaluate the morphology of glioblastoma on structural pretreatment magnetic resonance imaging (MRI), defining imaging prognostic factors.MethodWe conducted a retrospective analysis of MR images from 114 patients harboring a primary glioblastoma, derived from two neurosurgical departments. Tumor segmentation was carried out in a semi-automated fashion. Tumor compartments comprised contrast-enhancing volume (CEV+), perifocal hyperintensity on fluid-attenuated inversion recovery (FLAIR) images (FLAIR+) excluding CEV+, and a non-enhancing area within the CEV+ lesion (CEV−). Additionally, two ratios were calculated from these volumes, the edema-tumor ratio (ETR) and necrosis-tumor ratio (NTR). All patients received surgical resection, followed by concomitant radiation and chemotherapy.ResultsTumor segmentation revealed the strongest correlation between the CEV+ volume and the CEV−, presenting intratumoral necrosis (p < 0.001). The relation between the tumor surrounding the FLAIR+ area and the CEV+ volume and the ETR is inversely correlated (p = 0.001). The most important prognostic factor in multivariable analysis was NTR (HR 2.63, p = 0.016). The cut-off value in our cohort for NTR was 0.33, equivalent to a decrease in survival if the necrotic core of the tumor (CEV−) accounts for more than 33% of the tumor mass itself (CEV+).ConclusionsOur data emphasizes the importance of the necrosis-tumor ratio as a biomarker in glioblastoma imaging, rather than single tumor compartment volumes. NTR can help to identify a subset of tumors with a higher resistance to therapy and a dismal prognosis.
Item Description:Gesehen am 13.11.2019
Physical Description:Online Resource
ISSN:0942-0940
DOI:10.1007/s00701-019-03966-6

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