Survival analysis in patients with glioblastoma multiforme: predictive value of choline-to-N-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume

J Magn Reson Imaging. 2004 May;19(5):546-54. doi: 10.1002/jmri.20039.


Purpose: To investigate the potential value of pre-external-beam radiation therapy (XRT) choline-to-NAA (N-acetylaspartate) index (CNI), apparent diffusion coefficient (ADC), and relative cerebral blood volume (rCBV) for predicting survival in newly diagnosed patients with glioblastoma multiforme (GBM).

Materials and methods: Twenty-eight patients with GBM were studied using in vivo proton magnetic resonance spectroscopic imaging (1H MRSI) and diffusion- and perfusion-weighted imaging after surgery but prior to XRT. Patients were categorized on the basis of their volumes of morphologic and metabolic abnormalities (volume of CNI > or = 2 and CNI values), normalized ADC (nADC), or rCBV values within the T1 contrast-enhancing and T2 regions. The median survival time was compared.

Results: A significantly shorter median survival time was observed for patients with a large volume of metabolic abnormality than for those with a small abnormality (12.0 and 17.1 months, respectively, P = 0.002). A similar pattern was observed for patients with a low mean nADC value compared to those with high mean nADC value within the T2 region (11.2 and 21.7 months, respectively, P = 0.004). A shorter median survival time was also observed for patients with contrast-enhancing residual disease than for those without the presence of contrast enhancement with marginal significance.

Conclusion: The pre-XRT volume of the metabolic abnormality and the nADC value within the T2 region may be valuable in predicting outcome for patients with GBM.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aspartic Acid / analogs & derivatives*
  • Aspartic Acid / metabolism
  • Blood Volume
  • Brain Neoplasms / metabolism*
  • Brain Neoplasms / mortality*
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / radiotherapy
  • Choline / metabolism
  • Glioblastoma / metabolism*
  • Glioblastoma / mortality*
  • Glioblastoma / physiopathology
  • Glioblastoma / radiotherapy
  • Humans
  • Magnetic Resonance Spectroscopy
  • Middle Aged
  • Predictive Value of Tests
  • Protons
  • Survival Analysis


  • Protons
  • Aspartic Acid
  • N-acetylaspartate
  • Choline