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Dynamic contrast-enhanced MRI may be helpful to predict response and prognosis after bevacizumab treatment in patients with recurrent high-grade glioma: comparison with diffusion tensor and dynamic susceptibility contrast imaging

  • Diagnostic Neuroradiology
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Abstract

Purpose

We aimed to evaluate the utility of diffusion tensor imaging (DTI), dynamic contrast-enhanced (DCE), and dynamic susceptibility contrast (DSC) imaging for stratifying bevacizumab treatment outcomes in patients with recurrent high-grade glioma.

Methods

Fifty-three patients with recurrent high-grade glioma who underwent baseline magnetic resonance imaging including DTI, DCE, and DSC before bevacizumab treatment were included. The mean apparent diffusion coefficient, fractional anisotropy, normalized cerebral blood volume, normalized cerebral blood flow, volume transfer constant, rate transfer coefficient (Kep), extravascular extracellular volume fraction, and plasma volume fraction were assessed. Predictors of response status, progression-free survival (PFS), and overall survival (OS) were determined using logistic regression and Cox proportional hazard modeling.

Results

Responders (n = 16) showed significantly longer PFS and OS (P < 0.001) compared with nonresponders (n = 37). Multivariable analysis revealed that lower mean Kep (odds ratio = 0.01, P = 0.008) was the only independent predictor of favorable response after adjustment for age, isocitrate dehydrogenase (IDH) mutation status, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. Multivariable Cox proportional hazard modeling showed that a higher mean Kep was the only variable associated with shorter PFS (hazard ratio [HR] = 7.90, P = 0.006) and OS (HR = 9.71, P = 0.020) after adjustment for age, IDH mutation status, and MGMT promoter methylation status.

Conclusion

Baseline mean Kep may be a useful biomarker for predicting response and stratifying patient outcomes following bevacizumab treatment in patients with recurrent high-grade glioma.

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Data availability

Our anonymized data can be obtained by any qualified investigator for the purposes of replicating procedures and results after ethics clearance and approval by all authors.

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Funding

This research received funding from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2020R1A2C1003886), and from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2020R1I1A1A01071648).

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Yae Won Park, Sung Soo Ahn & Seung-Koo Lee

  2. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Ju Hyung Moon, Eui Hyun Kim, Seok-Gu Kang & Jong Hee Chang

  3. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Se Hoon Kim

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  1. Yae Won Park
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Correspondence to Sung Soo Ahn.

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Park, Y.W., Ahn, S.S., Moon, J.H. et al. Dynamic contrast-enhanced MRI may be helpful to predict response and prognosis after bevacizumab treatment in patients with recurrent high-grade glioma: comparison with diffusion tensor and dynamic susceptibility contrast imaging. Neuroradiology 63, 1811–1822 (2021). https://doi.org/10.1007/s00234-021-02693-z

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