Abstract
Simple SummaryAn accurate survival analysis is crucial for disease management in glioblastoma (GBM) patients. Due to the ability of the diffusion MRI techniques of providing a quantitative assessment of GBM tumours, an ever-growing number of studies aimed at investigating the role of diffusion MRI metrics in survival prediction of GBM patients. Since the role of diffusion MRI in prediction and evaluation of survival outcomes has not been fully addressed and results are often controversial or unsatisfactory, we performed this systematic review in order to collect, summarize and evaluate all studies evaluating the role of diffusion MRI metrics in predicting survival in GBM patients. We found that quantitative diffusion MRI metrics provide useful information for predicting survival outcomes in GBM patients, mainly in combination with other clinical and multimodality imaging parameters.Despite advances in surgical and medical treatment of glioblastoma (GBM), the medium survival is about 15 months and varies significantly, with occasional longer survivors and individuals whose tumours show a significant response to therapy with respect to others. Diffusion MRI can provide a quantitative assessment of the intratumoral heterogeneity of GBM infiltration, which is of clinical significance for targeted surgery and therapy, and aimed at improving GBM patient survival. So, the aim of this systematic review is to assess the role of diffusion MRI metrics in predicting survival of patients with GBM. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the association of diffusion MRI metrics with overall survival (OS) and progression-free survival (PFS). The quality of the included studies was evaluated using the QUIPS tool. A total of 52 articles were selected. The most examined metrics were associated with the standard Diffusion Weighted Imaging (DWI) (34 studies) and Diffusion Tensor Imaging (DTI) models (17 studies). Our findings showed that quantitative diffusion MRI metrics provide useful information for predicting survival outcomes in GBM patients, mainly in combination with other clinical and multimodality imaging parameters.
Highlights
Glioblastoma (GBM) is classified by World Health Organization as a grade IV astrocytoma and is the most common and fatal primary brain tumour of the central nervous system (CNS) in adults [1]
After having independently screened identified titles and abstracts, assessed the full text of the articles that evaluated at least one diffusion magnetic resonance imaging (MRI) metric in terms of overall survival (OS) or progression-free survival (PFS), and were not review articles. For articles meeting these criteria with full text available, the following further selection criteria had to be fulfilled: adult patients; patients with histopathologically confirmed GBM; and at least one diffusion MRI metric examined in terms of OS or PFS
This is mainly due to the ability of the diffusion MRI techniques of providing a quantitative assessment of intratumoral heterogeneity of GBM infiltration, which is of clinical significance for targeted surgery and therapy, and are crucial for improving GBM patient survival
Summary
Glioblastoma (GBM) is classified by World Health Organization as a grade IV astrocytoma and is the most common and fatal primary brain tumour of the central nervous system (CNS) in adults [1]. Given the urgent need for finding the optimal and targeted treatment option for GBM patients [29,30], and given the proven power of diffusion MRI techniques for applications such as preoperative grading, postoperative assessment of glial tumours and differentiation of GBM from other tumours types (such as brain metastasis or PCNSL [31,32,33]), several studied investigated the association of diffusion MRI metrics with survival outcomes in patients with GBM Some of these were performed on newly diagnosed GBM patients, while others on recurrent GBM patients. The aim of this systematic review is to collect, summarize and discuss all studies evaluating the role of diffusion MRI metrics in predicting survival in GBM patients and raise awareness for future research in this field
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