Abstract
BACKGROUND: MR perfusion (MRP) is a relatively new technique, which may aid in identifying tumour recurrence in those with radically treated high-grade gliomas (HGG). Salvage therapies can diminish quality of life; therefore, it is imperative to identify those with true recurrence who may benefit from additional treatment. We aim to assess the relationship between MRP and overall survival to establish the role of MRP as a clinical decision-making tool as well as a prognostic assessment tool. METHODS: A retrospective chart review of adult patients with histopathologically confirmed diagnosis of HGG and who have had at least one post-treatment MRP scan between January 2011 and April 2014 was conducted. MRP studies were interpreted by experienced radiologists based on relative cerebral blood volume (rCBV) colour maps. Survival data was collected from medical records and obituary databases. RESULTS: Sixty-one patients (mean age 56 years) with HGG (18 grade III, 43 grade IV) were included in the analysis. An increased survival benefit was observed in patients with negative MRP (median survival = 10 months) compared to those with positive MRP (median survival = 5 months), [hazard ratio (HR) = 2.51; 95% confidence interval (CI): 1.09 to 5.76; p = 0.03]. The adjusted analysis including all pre-selected variables demonstrated a similar relationship between MRP and overall survival [HR = 2.53; 95% CI: 1.05 to 6.14; p = 0.04]. Other independent predictors did not demonstrate a statistically significant association with overall survival. CONCLUSION: Our data suggest that a positive MRP result may signify the presence of highly active tumour and thus significantly lower overall survival. This implicates a prognostic role for the use of serial MRP studies to identify a time point in which tumour recurrence becomes highly aggressive, which can affect treatment determination and, more importantly, aid in clinical decision-making.
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