Investig Magn Reson Imaging.  2018 Sep;22(3):158-167. 10.13104/imri.2018.22.3.158.

Dynamic Susceptibility Contrast (DSC) Perfusion MR in the Prediction of Long-Term Survival of Glioblastomas (GBM): Correlation with MGMT Promoter Methylation and 1p/19q Deletions

• Kwon YW
• Moon WJ
• Park M
• Roh HG
• Koh YC
• Song SW
• Choi JW

• KMID: 2421547
• DOI: http://doi.org/10.13104/imri.2018.22.3.158

Abstract

PURPOSE
To investigate the surgical, perfusion, and molecular characteristics of glioblastomas which influence long-term survival after treatment, and to explore the association between MR perfusion parameters and the presence of MGMT methylation and 1p/19q deletions.
MATERIALS AND METHODS
This retrospective study was approved by our institutional review board. A total 43 patients were included, all with pathologic diagnosis of glioblastoma with known MGMT methylation and 1p/19q deletion statuses. We divided these patients into long-term (≥ 60 months, n = 7) and short-term (< 60 months, n = 36) survivors, then compared surgical extent, molecular status, and rCBV parameters between the two groups using Fisher's exact test or Mann-Whitney test. The rCBV parameters were analyzed according to the presence of MGMT methylation and 1p/19q deletions. We investigated the relationship between the mean rCBV and overall survival using linear correlation. Multivariable linear regression was performed in order to find the variables related to overall survival.
RESULTS
Long-term survivors (100% [7 of 7]) demonstrated a greater percentage of gross total or near total resection than short-term survivors (54.5% [18 of 33]). A higher prevalence of 1p/19q deletions was also noted among the long-term survivors (42.9% [3 of 7]) than the short-term survivors (0.0% [0 of 36]). The rCBV parameters did not differ between the long-term and short-term survivors. The rCBV values were marginally lower in patients with MGMT methylation and 1p/19q deletions. Despite no correlation found between overall survival and rCBV in the whole group, the short-term survivor group showed negative correlation (R2 = 0.181, P = 0.025). Multivariable linear regression revealed that surgical extent and 1p/19q deletions, but not rCBV values, were associated with prolonged overall survival.
CONCLUSION
While preoperative rCBV and 1p/19q deletion status are related to each other, only surgical extent and the presence of 1p/19q deletion in GBM patients may predict long-term survival.

Keyword

Original research; Glioblastoma; Perfusion imaging; Magnetic resonance image, Dynamic susceptibility contrast perfusion; Radiogenomics

MeSH Terms

Diagnosis
Ethics Committees, Research
Glioblastoma*
Humans
Linear Models
Methylation*
Perfusion Imaging
Perfusion*
Prevalence
Retrospective Studies
Survivors

Figure

• 

  Fig. 1. Study design diagram.

• 

  Fig. 2. Scatter plot of mean rCBV versus overall survival (in months) in GBM patients, including both long-term and short-term survivors. Although the scatter plot demonstrates a decreasing trend towards lower mean rCBV values with greater overall survival, the linear regression analysis did not demonstrate a statistically significant linear correlation (P = 0.186, R2 = 0.029).

• 

  Fig. 3. Scatter plot of mean rCBV versus overall survival (in months) in short-term GBM survivors. Linear regression analysis demonstrated the presence of a statistically significant negative linear correlation between mean rCBV and overall survival (P = 0.025, R2 = 0.181).

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  Fig. 4. A 47-year-old male with glioblastoma in the right frontal lobe. (a) T2-weighted image, (b) T1-weighted contrast-enhanced image, and (c) rCBV map are shown. The mean rCBV value measured from the enhanced part of the tumor was 1.95. Molecular analysis revealed both MGMT promoter methylation and 1p19q codeletion. The overall survival was 81 months.

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  Fig. 5. A 73-year-old male with glioblastoma in the left temporal lobe. (a) T2-weighted image, (b) T1-weighted contrast-enhanced image, and (c) rCBV map are shown. The mean rCBV value measured from the enhanced part of the tumor was 2.70. Molecular analysis revealed that both MGMT promoter and 1p19q were intact. The overall survival was 13 months.

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  Fig. 6. A 43-year-old female with glioblastoma in the right frontal lobe. (a) T2-weighted image, (b) T1-weighted contrast-enhanced image, and (c) rCBV map are shown. The mean rCBV value measured from the enhanced part of the tumor was 3.48. The molecular analysis revealed that both MGMT promoter and 1p19q were intact. The overall survival was 106 months.

Reference

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