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Gliomas: Predicting Time to Progression or Survival with Cerebral Blood Volume Measurements at Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging¹

¹ From the Departments of Radiology and Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029 (M.L.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.J.Y.); Departments of Radiology (J.S.B., N.P., S.C., G.J.), Neuro-oncology (M.L.G.), Pathology (D.C.M., D.Z.), and Neurosurgery (M.L.G., D.C.M., J.G.G., D.Z.), New York University Medical Center, New York, NY; and NYU Comprehensive Cancer Center, New York, NY (M.L.G., D.C.M., J.G.G., D.Z.). Received May 23, 2007; revision requested July 30; revision received August 13; accepted September 12; final version accepted December 6. Supported by grants RO1 CA093992, RO1 CA1111996, and R01 CA100426 from the National Institutes of Health. Address correspondence to M.L. (e-mail: Meng.law{at}mountsinai.org).

Purpose: To retrospectively determine whether relative cerebral blood volume (CBV) measurements can be used to predict clinical outcome in patients with high-grade gliomas (HGGs) and low-grade gliomas (LGGs) and specifically whether patients who have gliomas with a high initial relative CBV have more rapid progression than those who have gliomas with a low relative CBV.

Materials and Methods: Approval for this retrospective HIPAA-compliant study was obtained from the Institutional Board of Research Associates, with waiver of informed consent. One hundred eighty-nine patients (122 male and 67 female patients; median age, 43 years; range, 4–80 years) were examined with dynamic susceptibility-weighted contrast material–enhanced perfusion magnetic resonance (MR) imaging and were followed up clinically with MR imaging (median follow-up, 334 days). Log-rank tests were used to evaluate the association between relative CBV and time to progression by using Kaplan-Meier curves. Binary logistic regression was used to determine whether age, sex, and relative CBV were associated with an adverse event (progressive disease or death).

Results: Values for the mean relative CBV for patients according to each clinical response were as follows: 1.41 ± 0.13 (standard deviation) for complete response (n = 4), 2.36 ± 1.78 for stable disease (n = 41), 4.84 ± 3.32 for progressive disease (n = 130), and 3.82 ± 1.93 for death (n = 14). Kaplan-Meier estimates of median time to progression in days indicated that patients with a relative CBV of less than 1.75 had a median time to progression of 3585 days, whereas patients with a relative CBV of more than 1.75 had a time to progression of 265 days. Age and relative CBV were also independent predictors for clinical outcome.

Conclusion: Dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging can be used to predict median time to progression in patients with gliomas, independent of pathologic findings. Patients who have HGGs and LGGs with a high relative CBV (>1.75) have a significantly more rapid time to progression than do patients who have gliomas with a low relative CBV.

© RSNA, 2008