Abstract
Contrast enhancement is a crucial radiologic feature of malignant brain tumors, which are associated with genetic changes of the tumor. The purpose of the current study was to investigate the potential relationship among tumor contrast enhancement with MR imaging, vascular endothelial growth factor (VEGF) expression, and survival outcome in anaplastic gliomas. MR images from 240 patients with histologically confirmed anaplastic gliomas were retrospectively analyzed. The volumes of T2 hyperintense, contrast enhanced regions and necrotic regions on postcontrast T1-weighted images were measured. The ratio of the enhanced volume to necrotic volume was compared between patients with high versus low levels of VEGF expression and was further used in the survival analysis. The volumetric ratio of enhancement to necrosis was significantly higher in patients with low VEGF expression than in those with high VEGF expression (Mann-Whitney, p = 0.009). In addition, the enhancement/necrosis ratio was identified as a significant predictor of progression-free survival (Cox regression model, p = 0.004) and overall survival (Cox regression model, p = 0.006) in the multivariate analysis. These results suggest that the volumetric ratio of enhancement to necrosis could serve as a noninvasive radiographic marker associated with VEGF expression and that this ratio is an independent predictor for progression-free survival and overall survival in patients with anaplastic gliomas.
Highlights
Anaplastic gliomas (AG) are classified by the World Health Organization (WHO) as malignant tumors and include anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and anaplastic oligoastrocytoma (AOA)
With performing a volumetric neuroimaging analysis in a large patient cohort, the current study investigated the association between radiologic features, tumor-specific molecular markers (VEGF), and survival outcomes in patients with AG
There were other studies found that dynamic contrast enhancement MRI parameters were related to Vascular endothelial growth factor (VEGF) and microvessel density (MVD) and that the mean and peak intensity of contrast enhanced ultrasound were significantly associated with MVD counts and VEGF expression in breast cancer; besides, VEGF may enhance the hepatic mass with a contrast agent during CT [22,23,24]
Summary
Anaplastic gliomas (AG) are classified by the World Health Organization (WHO) as malignant tumors (grade III) and include anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and anaplastic oligoastrocytoma (AOA). These highly aggressive tumors often occur in adults between 40 to 50 years of age and typically recur or progress to grade IV glioblastomas within several years of diagnosis [1]. Established prognostic factors include the patient’s age, tumor grade and histologic features, extent of surgical resection, and KPS. VEGF expression promotes angiogenesis and the permeabilization of blood vessels, which is associated with the degree of enhancement in gliomas [10]. The relationship between VEGF and the radiologic enhancement of AG in humans has not been investigated
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