, Volume 58, Issue 1, pp 17–26 | Cite as

High-resolution blood-pool-contrast-enhanced MR angiography in glioblastoma: tumor-associated neovascularization as a biomarker for patient survival. A preliminary study

  • Josep PuigEmail author
  • Gerard Blasco
  • Josep Daunis-i-Estadella
  • Angel Alberich-Bayarri
  • Marco Essig
  • Rajan Jain
  • Sebastián Remollo
  • David Hernández
  • Montserrat Puigdemont
  • Javier Sánchez-González
  • Gloria Mateu
  • Max Wintermark
  • Salvador Pedraza
Diagnostic Neuroradiology



The objective of the study was to determine whether tumor-associated neovascularization on high-resolution gadofosveset-enhanced magnetic resonance angiography (MRA) is a useful biomarker for predicting survival in patients with newly diagnosed glioblastomas.


Before treatment, 35 patients (25 men; mean age, 64 ± 14 years) with glioblastoma underwent MRI including first-pass dynamic susceptibility contrast (DSC) perfusion and post-contrast T1WI sequences with gadobutrol (0.1 mmol/kg) and, 48 h later, high-resolution MRA with gadofosveset (0.03 mmol/kg). Volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter were obtained, and DSC perfusion and DWI parameters were evaluated. Prognostic factors were assessed by Kaplan-Meier survival and Cox proportional hazards model.


Eighteen (51.42 %) glioblastomas were hypervascular on high-resolution MRA. Hypervascular glioblastomas were associated with higher CEL volume and lower Karnofsky score. Median survival rates for patients with hypovascular and hypervascular glioblastomas treated with surgery, radiotherapy, and chemotherapy were 15 and 9.75 months, respectively (P < 0.001). Tumor-associated neovascularization was the best predictor of survival at 5.25 months (AUC = 0.794, 81.2 % sensitivity, 77.8 % specificity, 76.5 % positive predictive value, 82.4 % negative predictive value) and yielded the highest hazard ratio (P < 0.001).


Tumor-associated neovascularization detected on high-resolution blood-pool-contrast-enhanced MRA of newly diagnosed glioblastoma seems to be a useful biomarker that correlates with worse survival.


Brain neoplasms Glioblastoma Magnetic resonance imaging Angiography Survival 


Compliance with ethical standards

Ethical standards and patient consent

We declare that all human studies have been approved by the local Ethics Committee of Hospital Universitari Dr Josep Trueta in Girona and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Josep Puig
    • 1
    Email author
  • Gerard Blasco
    • 1
  • Josep Daunis-i-Estadella
    • 2
  • Angel Alberich-Bayarri
    • 3
  • Marco Essig
    • 4
  • Rajan Jain
    • 5
  • Sebastián Remollo
    • 1
  • David Hernández
    • 1
  • Montserrat Puigdemont
    • 6
  • Javier Sánchez-González
    • 7
  • Gloria Mateu
    • 2
  • Max Wintermark
    • 8
  • Salvador Pedraza
    • 1
  1. 1.Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology [Girona Biomedical Research Institute] IDIBGIHospital Universitari Dr Josep TruetaGironaSpain
  2. 2.Department of Computer Science, Applied Mathematics and StatisticsUniversity of GironaGironaSpain
  3. 3.Biomedical Imaging Research Group (GIBI230), La Fe Health Research InstituteLa Fe Polytechnics and University HospitalValenciaSpain
  4. 4.Department of RadiologyUniversity of ManitobaWinnipegCanada
  5. 5.Division of Neuroradiology, Department of RadiologyNYU School of MedicineNew YorkUSA
  6. 6.Catalan Institute of Oncology (ICO), Hospital Cancer RegistryHospital Universitari Dr Josep TruetaGironaSpain
  7. 7.Philips Healthcare IbéricaMadridSpain
  8. 8.Department of Radiology, Neuroradiology DivisionStanford UniversityPalo AltoUSA

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