Abstract
PurposeTo evaluate the usefulness of dynamic susceptibility contrast (DSC) enhanced perfusion MR imaging in predicting major genetic alterations in glioblastomas.Materials and MethodsTwenty-five patients (M:F = 13∶12, mean age: 52.1±15.2 years) with pathologically proven glioblastoma who underwent DSC MR imaging before surgery were included. On DSC MR imaging, the normalized relative tumor blood volume (nTBV) of the enhancing solid portion of each tumor was calculated by using dedicated software (Nordic TumorEX, NordicNeuroLab, Bergen, Norway) that enabled semi-automatic segmentation for each tumor. Five major glioblastoma genetic alterations (epidermal growth factor receptor (EGFR), phosphatase and tensin homologue (PTEN), Ki-67, O6-methylguanine-DNA methyltransferase (MGMT) and p53) were confirmed by immunohistochemistry and analyzed for correlation with the nTBV of each tumor. Statistical analysis was performed using the unpaired Student t test, ROC (receiver operating characteristic) curve analysis and Pearson correlation analysis.ResultsThe nTBVs of the MGMT methylation-negative group (mean 9.5±7.5) were significantly higher than those of the MGMT methylation-positive group (mean 5.4±1.8) (p = .046). In the analysis of EGFR expression-positive group, the nTBVs of the subgroup with loss of PTEN gene expression (mean: 10.3±8.1) were also significantly higher than those of the subgroup without loss of PTEN gene expression (mean: 5.6±2.3) (p = .046). Ki-67 labeling index indicated significant positive correlation with the nTBV of the tumor (p = .01).ConclusionWe found that glioblastomas with aggressive genetic alterations tended to have a high nTBV in the present study. Thus, we believe that DSC-enhanced perfusion MR imaging could be helpful in predicting genetic alterations that are crucial in predicting the prognosis of and selecting tailored treatment for glioblastoma patients.
Highlights
Malignant gliomas are the most common and lethal cancers originating in the brain
We found that glioblastomas with aggressive genetic alterations tended to have a high normalized relative tumor blood volume (nTBV) in the present study
We believe that dynamic susceptibility contrast (DSC)-enhanced perfusion MR imaging could be helpful in predicting genetic alterations that are crucial in predicting the prognosis of and selecting tailored treatment for glioblastoma patients
Summary
Malignant gliomas are the most common and lethal cancers originating in the brain. Glioblastoma multiforme (GBM, World Health Organization [WHO] Grade IV), the most aggressive subtype of glioma, has a dismal prognosis. The most accurate method for the identification of genetic alterations in GBM is pathologic analysis. It is potentially dangerous to sample tissue from patients who are in poor general condition for brain surgery, who have tumors in a critical portion of the brain or who have recurrent tumors on follow-up images after treatment involving surgery. These tissuebased methods are often associated with sampling errors due to improper resection or biopsy of tumor tissues and heterogeneity of tumors, resulting in some cases with false genetic profile assignation. Preoperative insight into the genetic composition of the tumor is sometimes, if not often, necessary to guide preoperative chemotherapies to shrink the tumor
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