Intravoxel Incoherent Motion Metrics as Potential Biomarkers for Survival in Glioblastoma

PLoS One. 2016 Jul 7;11(7):e0158887. doi: 10.1371/journal.pone.0158887. eCollection 2016.

Abstract

Objective: Intravoxel incoherent motion (IVIM) is an MRI technique with potential applications in measuring brain tumor perfusion, but its clinical impact remains to be determined. We assessed the usefulness of IVIM-metrics in predicting survival in newly diagnosed glioblastoma.

Methods: Fifteen patients with glioblastoma underwent MRI including spin-echo echo-planar DWI using 13 b-values ranging from 0 to 1000 s/mm2. Parametric maps for diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were generated for contrast-enhancing regions (CER) and non-enhancing regions (NCER). Regions of interest were manually drawn in regions of maximum f and on the corresponding dynamic susceptibility contrast images. Prognostic factors were evaluated by Kaplan-Meier survival and Cox proportional hazards analyses.

Results: We found that fCER and D*CER correlated with rCBFCER. The best cutoffs for 6-month survival were fCER>9.86% and D*CER>21.712 x10-3mm2/s (100% sensitivity, 71.4% specificity, 100% and 80% positive predictive values, and 80% and 100% negative predictive values; AUC:0.893 and 0.857, respectively). Treatment yielded the highest hazard ratio (5.484; 95% CI: 1.162-25.88; AUC: 0.723; P = 0.031); fCER combined with treatment predicted survival with 100% accuracy.

Conclusions: The IVIM-metrics fCER and D*CER are promising biomarkers of 6-month survival in newly diagnosed glioblastoma.

MeSH terms

  • Aged
  • Biomarkers / metabolism*
  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / mortality*
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / mortality*
  • Humans
  • Image Processing, Computer-Assisted
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Motion*
  • Observer Variation
  • Perfusion
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Sensitivity and Specificity
  • Treatment Outcome

Substances

  • Biomarkers

Grant support

The authors received no specific funding for this work. Javier Sánchez-González is employed by Philips Healthcare Ibérica. Philips Healthcare Ibérica provided support in the form of salary for author Javier Sánchez-González, but this company did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.