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Survival prediction in high-grade gliomas using CT perfusion imaging

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An Erratum to this article was published on 29 September 2015

Abstract

Patients with high-grade gliomas usually have heterogeneous response to surgery and chemoirradiation. The objectives of this study were (1) to evaluate serial changes in tumor volume and perfusion imaging parameters and (2) to determine the value of these data in predicting overall survival (OS). Twenty-nine patients with World Health Organization grades III and IV gliomas underwent magnetic resonance (MR) and computed tomography (CT) perfusion examinations before surgery, and 1, 3, 6, 9, and 12 months after radiotherapy. Serial measurements of tumor volumes and perfusion parameters were evaluated by receiver operating characteristic analysis, Cox proportional hazards regression, and Kaplan–Meier survival analysis to determine their values in predicting OS. Higher trends in blood flow (BF), blood volume (BV), and permeability-surface area product in the contrast-enhancing lesions (CEL) and the non-enhancing lesions (NEL) were found in patients with OS < 18 months compared to those with OS ≥ 18 months, and these values were significant at selected time points (P < 0.05). Only CT perfusion parameters yielded sensitivities and specificities of ≥70 % in predicting 18 and 24 months OS. Pre-surgery BF in the NEL and BV in the CEL and NEL 3 months after radiotherapy had sensitivities and specificities >80 % in predicting 24 months OS in patients with grade IV gliomas. Our study indicated that CT perfusion parameters were predictive of survival and could be useful in assessing early response and in selecting adjuvant treatment to prolong survival if verified in a larger cohort of patients.

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Acknowledgments

This project was funded by The Project of Emilia-Romagna region on Neuro-Oncology (PERNO) study group, the Canadian Institutes of Health Research (CIHR), and the CIHR Strategic Training Program in Cancer Research and Technology Transfer.

Funding

Ting-Yim Lee licenses CT Perfusion software to and receives funding from GE Healthcare.

Author information

Authors and Affiliations

  1. Department of Medical Biophysics, Western University, London, ON, Canada

    Timothy Pok Chi Yeung, Slav Yartsev, Glenn Bauman & Ting-Yim Lee

  2. Robarts Research Institute, P.O. Box 5015, 100 Perth Drive, London, ON, Canada

    Timothy Pok Chi Yeung, Yong Wang & Ting-Yim Lee

  3. Department of Oncology, Western University, London, ON, Canada

    Slav Yartsev, Glenn Bauman & Ting-Yim Lee

  4. Department of Statistical and Actuarial Sciences, Western University, London, ON, Canada

    Wenqing He

  5. Oncology Unit, Specialized Medical Department, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy

    Benedetta Urbini

  6. London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada

    Timothy Pok Chi Yeung, Slav Yartsev & Glenn Bauman

  7. Department of Medical Imaging, Western University, London, ON, Canada

    Ting-Yim Lee

  8. Lawson Health Research Institute, London, ON, Canada

    Ting-Yim Lee

  9. Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy

    Enrico Fainardi

  10. Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Roberta Gafà & Linda Ulazzi

Authors
  1. Timothy Pok Chi Yeung
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  2. Yong Wang
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Consortia

The Project of Emilia-Romagna Region on Neuro-Oncology (PERNO) Study Group

Corresponding author

Correspondence to Ting-Yim Lee.

Additional information

A complete list of the members of the PERNO study group appears in the “Appendix”.

Electronic supplementary material

Below is the link to the electronic supplementary material.

11060_2015_1766_MOESM1_ESM.tif

Supplementary Figure S1. Serial changes in mean volumes (top  row), blood flow (BF, second  row), blood volume (BV, third  row), and permeability-surface area product (PS, bottom  row) in the contrast-enhancing lesions (CEL) of patients stratified by a 12 and b 24 months (mo) overall survival (OS). Horizontal  line connects significant changes between two time points of the same group. Dotted  box encloses a significant difference between the groups at a particular time point. Error  bar represents one standard deviation (TIFF 159 kb)

11060_2015_1766_MOESM2_ESM.tif

Supplemeantary Figure S2. Serial changes in mean volumes (top  row), blood flow (BF, second  row), blood volume (BV, third  row), and permeability-surface area product (PS, bottom  row) in the non-enhancing lesion (NEL) of patients stratified by a 12 and b 24 months (mo) overall survival (OS). Horizontal  line connects significant changes between two time points of the same group. Dotted box encloses a significant difference between the groups at a particular time point. Error  bar represents one standard deviation (TIFF 155 kb)

Appendix

Appendix

Steering committee

Baruzzi A. (Chair), Albani F., Calbucci F., D'Alessandro R., Michelucci R. (IRCCS Institute of Neurological Sciences, Bologna, Italy), Brandes A. (Department of Medical Oncology, Bellaria-Maggiore Hospitals, Bologna, Italy), Eusebi V. (Department of Hematology and Oncological Sciences “L. & A. Seràgnoli”, Section of Anatomic Pathology at Bellaria Hospital, Bologna, Italy), Ceruti S., Fainardi E., Tamarozzi R. (Neuroradiology Unit, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy), Emiliani E. (Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna, Italy), Cavallo M. (Division of Neurosurgery, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy).

Executive committee

Franceschi E., Tosoni A. (Department of Medical Oncology, Bellaria-Maggiore Hospitals, Bologna, Italy), Cavallo M. (Division of Neurosurgery, Department of Neurosciences and Rehabilitation, S. Anna Hospital, Ferrara, Italy), Fiorica F. (Department of Radiation Oncology, S. Anna Hospital, Ferrara, Italy), Valentini A. (Division of Neurosurgery, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara, Modena, Italy), Depenni R. (Department of Oncology, Policlinico di Modena, Italy), Mucciarini C. (Department of Oncology, Ramazzini Hospital, Carpi, Modena, Italy), Crisi G. (Department of Neuroradiology, Maggiore Hospital, Parma, Italy), Sasso E. (Department of Neurological Sciences, Maggiore Hospital, Parma, Italy), Biasini C., Cavanna L. (Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy), Guidetti D. (Department of Neurology, Guglielmo da Saliceto Hospital, Piacenza, Italy), Marcello N., Pisanello A. (Department of Neurology, Istituto in tecnologie avanzate e modelli assistenziali in oncologia, IRCCS, S. Maria Nuova Hospital, Reggio Emilia, Italy), Cremonini A.M., Guiducci G. (Division of Neurosurgery, M. Bufalini Hospital, Cesena, Italy).

Registry Coordination Office: de Pasqua S., Testoni S. (IRCCS Institute of Neurological Sciences, Bologna, Italy).

Participants

Agati R., Ambrosetto G., Bacci A., Baldin E., Baldrati A., Barbieri E., Bartolini S., Bellavista E., Bisulli F., Bonora E., Bunkheila F., Carelli V., Crisci M., Dall'Occa P., Ferro S., Franceschi C., Frezza G., Grasso V., Leonardi M., Morandi L., Mostacci B., Palandri G., Pasini E., Pastore Trossello M., Poggi R., Riguzzi P., Rinaldi R., Rizzi S., Romeo G., Spagnolli F., Tinuper P., Trocino C. (Bologna), Dall'Agata M., Frattarelli M., Gentili G., Giovannini A., Iorio P., Pasquini U., Galletti G., Guidi C., Neri W., Patuelli A., Strumia S. (Forlì-Cesena), Faedi M. (IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), Casmiro M., Gamboni A., Rasi F. (Faenza R.A.), Cruciani G. (Lugo, RA), Cenni P., Dazzi C., Guidi A.R., Zumaglini F. (Ravenna), Amadori A., Pasini G., Pasquinelli M., Pasquini E., Polselli A., Ravasio A., Viti B. (Rimini), Sintini M. (Cattolica, RN), Ariatti A., Bertolini F., Bigliardi G., Carpeggiani P., Cavalleri F., Meletti S., Nichelli P., Pettorelli E., Pinna G., Zunarelli E. (Modena), Artioli F., Bernardini I., Costa M., Greco G., Guerzoni R., Stucchi C. (Carpi M.O.), Iaccarino C., Ragazzi M., Rizzi R., Zuccoli G. (Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia), Api P., Cartei F., Colella M., Fallica E., Farneti M., Frassoldati A., Granieri E., Latini F., Monetti C., Saletti A., Schivalocchi R., Sarubbo S., Seraceni S., Tola M.R., Urbini B., Zini G. (Ferrara), Giorgi C., Montanari E. (Fidenza P.R.), Cerasti D., Crafa P., Dascola I., Florindo I., Giombelli E., Mazza S., Ramponi V., Servadei F., Silini E.M., Torelli P. (Parma), Immovilli P., Morelli N., Vanzo C. (Piacenza), Nobile C. (Padova).

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Yeung, T.P.C., Wang, Y., He, W. et al. Survival prediction in high-grade gliomas using CT perfusion imaging. J Neurooncol 123, 93–102 (2015). https://doi.org/10.1007/s11060-015-1766-5

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