Abstract
The period of event-free survival (EFS) within the same histopathological glioma grades may have high variability, mainly without a known cause. The purpose of this study was to reveal the prognostic value of quantified tumor blood flow (TBF) values obtained by arterial spin labeling (ASL) for EFS in patients with histopathologically proven astrocytomas independent of WHO (World Health Organization) grade. Twenty-four patients with untreated gliomas underwent tumor perfusion quantification by means of pulsed ASL in 3T. The clinical history of the patients was retrospectively extracted from the local database. Six patients had to be excluded due to insufficent follow-up data for further evaluation or histopathologically verified oligodendroglioma tumor components. Receiver operating characteristic (ROC) curves were used to define an optimal cut-off value of maximum TBF (mTBF) values for subgrouping in low-perfused and high-perfused gliomas. Kaplan-Meier curves and Cox proportional hazard regression model were used to determine the prognostic value of mTBF for EFS. An optimal mTBF cut-off value of 182 ml/100 g/min (sensitivity = 83%, specificity = 100%) was determined. Patients with low-perfused gliomas had significantly longer EFS compared to patients with high-perfused gliomas (p = 0.0012) independent of the WHO glioma grade. Quantified mTBF values obtained by ASL offer a new and totally non-invasive marker to prognosticate the EFS, independently on histopathological tumor grading, in patients with gliomas.
Highlights
In spite of perpetual advancements in glioma treatment the prognosis of glial brain tumors, especially high-grade gliomas, remains poor with a mean progression free survival of about 16.5 and 6.8 months in anaplastic astrocytomas and glioblastomas respectively [1,2]
The maximum TBF (mTBF) values of all gliomas ranged from 82–599 ml/ 100 g/min
Tumors with mTBF#182 ml/ 100 g/min were referred as low-perfused gliomas (n = 8), whereas tumors with mTBF.182 ml/100 g/min were classified as highperfused gliomas (n = 10)
Summary
In spite of perpetual advancements in glioma treatment the prognosis of glial brain tumors, especially high-grade gliomas, remains poor with a mean progression free survival of about 16.5 and 6.8 months in anaplastic astrocytomas and glioblastomas respectively [1,2]. Inter- and intra-pathologist variability may lead to an inaccurate tumor evaluation [4,5,6]. Such sources of diagnostic inaccuracies in histopathology may be the reason for the observed variability of progression-free survival duration in patients with similar histopathological tumor grades. Additional diagnostic markers with implications for tumor recurrence and progression would be valuable. Under this scope and apart from molecular markers [2], different non-invasive, imaging markers have turned out to be predictive as well as prognosticative for progression-free survival in gliomas. That this technique relies on the intravenous application of contrast media it could pose a challenge for people with allergic reactions to contrast media and for patients with impaired kidney function, in whom the application of gadolinium-based contrast media could, in rare cases, lead to nephrogenic systemic fibrosis [8]
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