Ventricle contact is associated with lower survival and increased peritumoral perfusion in glioblastoma

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OBJECTIVE

The purpose of this study was to prospectively investigate outcome and differences in peritumoral MRI characteristics of glioblastomas (GBMs) that were in contact with the ventricles (ventricle-contacting tumors) and those that were not (noncontacting tumors). GBMs are heterogeneous tumors with variable survival. Lower survival is suggested for patients with ventricle-contacting tumors than for those with noncontacting tumors. This might be supported by aggressive peritumoral MRI features. However, differences in MRI characteristics of the peritumoral environment between ventricle-contacting and noncontacting GBMs have not yet been investigated.

METHODS

Patients with newly diagnosed GBM underwent preoperative MRI with contrast-enhanced T1-weighted, FLAIR, diffusion-weighted, and perfusion-weighted sequences. Tumors were categorized into ventricle-contacting or noncontacting based on contrast enhancement. Survival analysis was performed using log-rank for univariate analysis and Cox regression for multivariate analysis. Normalized perfusion (relative cerebral blood volume [rCBV]) and diffusion (apparent diffusion coefficient [ADC]) values were calculated in 2 regions: the peritumoral nonenhancing FLAIR region overlapping the subventricular zone and the remaining peritumoral nonenhancing FLAIR region.

RESULTS

Overall survival was significantly lower for patients with contacting tumors than for those with noncontacting tumors (434 vs 747 days, p < 0.001). Progression-free survival showed a comparable trend (260 vs 375 days, p = 0.094). Multivariate analysis confirmed a survival difference for both overall survival (HR 3.930, 95% CI 1.740–8.875, p = 0.001) and progression-free survival (HR 2.506, 95% CI 1.254–5.007, p = 0.009). Peritumoral perfusion was higher in contacting than in noncontacting tumors for both FLAIR regions (p = 0.04). There was no difference in peritumoral ADC values between the 2 groups.

CONCLUSIONS

Patients with ventricle-contacting tumors had poorer outcomes than patients with noncontacting tumors. This disadvantage of ventricle contact might be explained by higher peritumoral perfusion leading to more aggressive behavior.

ABBREVIATIONS 5-ALA = 5-aminolevulinic acid; ADC = apparent diffusion coefficient; DWI = diffusion-weighted imaging; FLAIR = fluid-attenuated inversion recovery; FOV = field of view; GBM = glioblastoma; IDH = isocitrate dehydrogenase; MGMT = O6-methylguanine-DNA-methyltransferase; PWI = perfusion-weighted imaging; RANO = Response Assessment in Neuro-Oncology; rCBV = relative cerebral blood volume; SVZ = subventricular zone; TE = echo time; TI = inversion time; TR = repetition time.

Article Information

Correspondence Bart Roelf Jan van Dijken: University Medical Center Groningen, The Netherlands. b.r.j.van.dijken@umcg.nl.

INCLUDE WHEN CITING Published online October 19, 2018; DOI: 10.3171/2018.5.JNS18340.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Regions of interest. Representative MR images obtained in a patient with a ventricle-contacting glioblastoma (upper row) and a patient with a noncontacting glioblastoma (lower row). A and D: Contrast-enhanced T1 weighted images with a 5-mm SVZ surrounding the ventricles (blue). B and E: FLAIR images. The overlap between the high FLAIR signal and the SVZ was included as the first region of interest (yellow). C and F: The remaining high FLAIR signal outside the T1 contrast-enhancing lesion without SVZ overlap was included as the peritumoral region of interest (red).

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    Kaplan-Meier survival curves for patients with ventricle-contacting and noncontacting GBMs. Survival curves for patients with ventricle-contacting tumors (solid line) and noncontacting tumors (dashed line). A: Overall survival. B: Progression-free survival. C: Survival after progression. Survival in days is displayed on the x-axis, with cumulative survival shown on the y-axis.

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