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Prediction of Response to Concurrent Chemoradiotherapy with Temozolomide in Glioblastoma: Application of Immediate Post-Operative Dynamic Susceptibility Contrast and Diffusion-Weighted MR Imaging.

Lee EK, Choi SH, Yun TJ, Kang KM, Kim TM, Lee SH, Park CK, Park SH, Kim IH - Korean J Radiol (2015)

Bottom Line: The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033).The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026).The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.

ABSTRACT

Objective: To determine whether histogram values of the normalized apparent diffusion coefficient (nADC) and normalized cerebral blood volume (nCBV) maps obtained in contrast-enhancing lesions detected on immediate post-operative MR imaging can be used to predict the patient response to concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ).

Materials and methods: Twenty-four patients with GBM who had shown measurable contrast enhancement on immediate post-operative MR imaging and had subsequently undergone CCRT with TMZ were retrospectively analyzed. The corresponding histogram parameters of nCBV and nADC maps for measurable contrast-enhancing lesions were calculated. Patient groups with progression (n = 11) and non-progression (n = 13) at one year after the operation were identified, and the histogram parameters were compared between the two groups. Receiver operating characteristic (ROC) analysis was used to determine the best cutoff value for predicting progression. Progression-free survival (PFS) was determined with the Kaplan-Meier method and the log-rank test.

Results: The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033). ROC analysis showed that the best cutoff value for predicting progression after CCRT was 5.537 (sensitivity and specificity were 72.7% and 76.9%, respectively). The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026).

Conclusion: The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.

No MeSH data available.


Related in: MedlinePlus

Representative example of MR images, nCBV maps, nADC maps and corresponding histograms in 70-year-old man with progression and in 60-year-old man with non-progression.A. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 70-year-old man shows measurable enhancement at posterior aspect of tumor resection margin. B. nCBV map shows increased nCBV with (C) slightly decreased ADC in enhancing lesion. E. Normalized CBV histograms and cumulative histograms of enhancing lesion. Histogram for entire contrast-enhancing lesion shows higher frequency of high nCBVs compared with 60-year-old man (K). F. Normalized ADC histograms and cumulative histograms of enhancing lesion. D. According to follow-up MR images acquired after adjuvant TMZ, there was increase in enhancement of lesion and patients were confirmed as progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide G. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 60-year-old man shows measurable enhancement at posteroinferior aspect of tumor resection margin. H. nCBV map shows slightly increased nCBV with (I) slightly decreased ADC in enhancing lesion. K. Normalized CBV histograms and cumulative histograms of enhancing lesion. L. Normalized ADC histograms and cumulative histograms of enhancing lesion. J. According to follow-up MR images acquired after continuing adjuvant TMZ, enhancement of lesion was decreased and patients were confirmed as non-progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide
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Figure 1: Representative example of MR images, nCBV maps, nADC maps and corresponding histograms in 70-year-old man with progression and in 60-year-old man with non-progression.A. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 70-year-old man shows measurable enhancement at posterior aspect of tumor resection margin. B. nCBV map shows increased nCBV with (C) slightly decreased ADC in enhancing lesion. E. Normalized CBV histograms and cumulative histograms of enhancing lesion. Histogram for entire contrast-enhancing lesion shows higher frequency of high nCBVs compared with 60-year-old man (K). F. Normalized ADC histograms and cumulative histograms of enhancing lesion. D. According to follow-up MR images acquired after adjuvant TMZ, there was increase in enhancement of lesion and patients were confirmed as progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide G. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 60-year-old man shows measurable enhancement at posteroinferior aspect of tumor resection margin. H. nCBV map shows slightly increased nCBV with (I) slightly decreased ADC in enhancing lesion. K. Normalized CBV histograms and cumulative histograms of enhancing lesion. L. Normalized ADC histograms and cumulative histograms of enhancing lesion. J. According to follow-up MR images acquired after continuing adjuvant TMZ, enhancement of lesion was decreased and patients were confirmed as non-progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide

Mentions: Table 2 summarizes the nCBV and nADC histogram parameters between the progression and non-progression groups. The nCBV C99 on immediate post-operative MR imaging was significantly higher in the progression group than in the non-progression group (p = 0.033) (Fig. 1), although all other parameters showed no significant difference between the two groups. ROC analysis of nCBV C99 showed that the best cutoff value for predicting progression after CCRT was 5.537, which had a sensitivity and specificity of 72.7% (8 of 11 patients) and 76.9% (10 of 13), respectively.


Prediction of Response to Concurrent Chemoradiotherapy with Temozolomide in Glioblastoma: Application of Immediate Post-Operative Dynamic Susceptibility Contrast and Diffusion-Weighted MR Imaging.

Lee EK, Choi SH, Yun TJ, Kang KM, Kim TM, Lee SH, Park CK, Park SH, Kim IH - Korean J Radiol (2015)

Representative example of MR images, nCBV maps, nADC maps and corresponding histograms in 70-year-old man with progression and in 60-year-old man with non-progression.A. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 70-year-old man shows measurable enhancement at posterior aspect of tumor resection margin. B. nCBV map shows increased nCBV with (C) slightly decreased ADC in enhancing lesion. E. Normalized CBV histograms and cumulative histograms of enhancing lesion. Histogram for entire contrast-enhancing lesion shows higher frequency of high nCBVs compared with 60-year-old man (K). F. Normalized ADC histograms and cumulative histograms of enhancing lesion. D. According to follow-up MR images acquired after adjuvant TMZ, there was increase in enhancement of lesion and patients were confirmed as progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide G. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 60-year-old man shows measurable enhancement at posteroinferior aspect of tumor resection margin. H. nCBV map shows slightly increased nCBV with (I) slightly decreased ADC in enhancing lesion. K. Normalized CBV histograms and cumulative histograms of enhancing lesion. L. Normalized ADC histograms and cumulative histograms of enhancing lesion. J. According to follow-up MR images acquired after continuing adjuvant TMZ, enhancement of lesion was decreased and patients were confirmed as non-progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4644757&req=5

Figure 1: Representative example of MR images, nCBV maps, nADC maps and corresponding histograms in 70-year-old man with progression and in 60-year-old man with non-progression.A. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 70-year-old man shows measurable enhancement at posterior aspect of tumor resection margin. B. nCBV map shows increased nCBV with (C) slightly decreased ADC in enhancing lesion. E. Normalized CBV histograms and cumulative histograms of enhancing lesion. Histogram for entire contrast-enhancing lesion shows higher frequency of high nCBVs compared with 60-year-old man (K). F. Normalized ADC histograms and cumulative histograms of enhancing lesion. D. According to follow-up MR images acquired after adjuvant TMZ, there was increase in enhancement of lesion and patients were confirmed as progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide G. Contrast-enhanced T1-weighted MR imaging obtained immediately after gross total resection from 60-year-old man shows measurable enhancement at posteroinferior aspect of tumor resection margin. H. nCBV map shows slightly increased nCBV with (I) slightly decreased ADC in enhancing lesion. K. Normalized CBV histograms and cumulative histograms of enhancing lesion. L. Normalized ADC histograms and cumulative histograms of enhancing lesion. J. According to follow-up MR images acquired after continuing adjuvant TMZ, enhancement of lesion was decreased and patients were confirmed as non-progression. nADC = normalized apparent diffusion coefficient, nCBV = normalized cerebral blood volume, TMZ = temozolomide
Mentions: Table 2 summarizes the nCBV and nADC histogram parameters between the progression and non-progression groups. The nCBV C99 on immediate post-operative MR imaging was significantly higher in the progression group than in the non-progression group (p = 0.033) (Fig. 1), although all other parameters showed no significant difference between the two groups. ROC analysis of nCBV C99 showed that the best cutoff value for predicting progression after CCRT was 5.537, which had a sensitivity and specificity of 72.7% (8 of 11 patients) and 76.9% (10 of 13), respectively.

Bottom Line: The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033).The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026).The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea.

ABSTRACT

Objective: To determine whether histogram values of the normalized apparent diffusion coefficient (nADC) and normalized cerebral blood volume (nCBV) maps obtained in contrast-enhancing lesions detected on immediate post-operative MR imaging can be used to predict the patient response to concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ).

Materials and methods: Twenty-four patients with GBM who had shown measurable contrast enhancement on immediate post-operative MR imaging and had subsequently undergone CCRT with TMZ were retrospectively analyzed. The corresponding histogram parameters of nCBV and nADC maps for measurable contrast-enhancing lesions were calculated. Patient groups with progression (n = 11) and non-progression (n = 13) at one year after the operation were identified, and the histogram parameters were compared between the two groups. Receiver operating characteristic (ROC) analysis was used to determine the best cutoff value for predicting progression. Progression-free survival (PFS) was determined with the Kaplan-Meier method and the log-rank test.

Results: The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033). ROC analysis showed that the best cutoff value for predicting progression after CCRT was 5.537 (sensitivity and specificity were 72.7% and 76.9%, respectively). The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026).

Conclusion: The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.

No MeSH data available.


Related in: MedlinePlus