Multiparametric MRI and [18F] fluorodeoxyglucose positron emission tomography imaging is a potential prognostic imaging biomarker in recurrent glioblastoma

Comron Hassanzadeh, Yuan James Rao, Anupama Chundury, Jackson Rowe, Maria Rosana Ponisio, Akash Sharma, Michelle Miller-Thomas, Christina I. Tsien, Joseph E. Ippolito

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose/objectives: Multiparametric advanced MR and [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging may be important biomarkers for prognosis as well for distinguishing recurrent glioblastoma multiforme (GBM) from treatment- related changes. Methods/materials: We retrospectively evaluated 30 patients treated with chemoradiation for GBM and underwent advanced MR and FDG-PET for confirmation of tumor progression. Multiparametric MRI and FDG-PET imaging metrics were evaluated for their association with 6-month overall (OS) and progression-free survival (PFS) based on pathological, radiographic, and clinical criteria. results: 17 males and 13 females were treated between 2001 and 2014, and later underwent FDG-PET at suspected recurrence. Baseline FDG-PET and MRI imaging was obtained at a median of 7.5 months [interquartile range (IQR) 3.7-12.4] following completion of chemoradiation. Median follow-up after FDG-PET imaging was 10 months (IQR 7.2-13.0). Receiver-operator characteristic curve analysis identified that lesions characterized by a ratio of the SUVmax to the normal contralateral brain (SUVmax/NB index) > 1.5 and mean apparent diffusion coefficient (ADC) value of =1,400 × 10-6 mm2/s correlated with worse 6-month OS and PFS. We defined three patient groups that predicted the probability of tumor progression: SUVmax/NB index > 1.5 and ADC ≤1,400 × 10-6 mm2/s defined high-risk patients (n = 7), SUVmax/NB index ≤1.5 and ADC > 1,400 × 10-6 mm2/s defined low-risk patients (n = 11), and intermediate-risk (n = 12) defined the remainder of the patients. Median OS following the time of the FDG-PET scan for the low, intermediate, and high-risk groups were 23.5, 10.5, and 3.8 months (p < 0.01). Median PFS were 10.0, 4.4, and 1.9 months (p = 0.03). Rates of progression at 6-months in the low, intermediate, and high-risk groups were 36, 67, and 86% (p = 0.04). conclusion:Recurrent GBM in the molecular era is associated with highly variable outcomes. Multiparametric MR and FDG-PET biomarkers may provide a clinically relevant, non-invasive and cost-effective method of predicting prognosis and improving clinical decision making in the treatment of patients with suspected tumor recurrence.

Original languageEnglish (US)
Article number178
JournalFrontiers in Oncology
Volume7
Issue numberAUG
DOIs
StatePublished - Aug 18 2017
Externally publishedYes

Keywords

  • Apparent diffusion coefficient
  • Diffusion
  • Glioblastoma
  • MRI
  • Radiation
  • Radionecrosis
  • [18F]fluorodeoxyglucose-positron emission tomography

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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