PMID- 31005212
OWN - NLM
STAT- MEDLINE
DCOM- 20200327
LR  - 20240210
IS  - 1879-0887 (Electronic)
IS  - 0167-8140 (Print)
IS  - 0167-8140 (Linking)
VI  - 134
DP  - 2019 May
TI  - Low perfusion compartments in glioblastoma quantified by advanced magnetic 
      resonance imaging and correlated with patient survival.
PG  - 17-24
LID - S0167-8140(19)30012-X [pii]
LID - 10.1016/j.radonc.2019.01.008 [doi]
AB  - BACKGROUND AND PURPOSE: Glioblastoma exhibits profound intratumoral heterogeneity 
      in perfusion. Particularly, low perfusion may induce treatment resistance. Thus, 
      imaging approaches that define low perfusion compartments are crucial for 
      clinical management. MATERIALS AND METHODS: A total of 112 newly diagnosed 
      glioblastoma patients were prospectively recruited for maximal safe resection. 
      The apparent diffusion coefficient (ADC) and relative cerebral blood volume 
      (rCBV) were calculated from diffusion and perfusion imaging, respectively. Based 
      on the overlapping regions of lowest rCBV quartile (rCBV(L)) with the lowest ADC 
      quartile (ADC(L)) and highest ADC quartile (ADC(H)) in each tumor, two low 
      perfusion compartments (ADC(H)-rCBV(L) and ADC(L)-rCBV(L)) were identified for 
      volumetric analysis. Lactate and macromolecule/lipid levels were determined from 
      multivoxel MR spectroscopic imaging. Progression-free survival (PFS) and overall 
      survival (OS) were analyzed using Kaplan-Meier's and multivariate Cox regression 
      analyses, to evaluate the effects of compartment volume and lactate level on 
      survival. RESULTS: Two compartments displayed higher lactate and 
      macromolecule/lipid levels compared to contralateral normal-appearing white 
      matter (each P < 0.001). The proportion of the ADC(L)-rCBV(L) compartment in the 
      contrast-enhancing tumor was associated with a larger infiltration on FLAIR 
      (P < 0.001, rho = 0.42). The minimally invasive phenotype displayed a lower 
      proportion of the ADC(L)-rCBV(L) compartment than the localized (P = 0.031) and 
      diffuse phenotypes (not significant). Multivariate Cox regression showed higher 
      lactate level in the ADC(L)-rCBV(L) compartment was associated with worsened 
      survival (PFS: HR 2.995, P = 0.047; OS: HR 4.974, P = 0.005). CONCLUSIONS: Our 
      results suggest that the ADC(L)-rCBV(L) compartment may potentially indicate a 
      clinically measurable resistant compartment.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Li, Chao
AU  - Li C
AD  - Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department 
      of Clinical Neuroscience, University of Cambridge, UK; Department of 
      Neurosurgery, Shanghai General Hospital (originally named "Shanghai First 
      People's Hospital"), Shanghai Jiao Tong University School of Medicine, China; 
      EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, UK. 
      Electronic address: cl647@cam.ac.uk.
FAU - Yan, Jiun-Lin
AU  - Yan JL
AD  - Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department 
      of Clinical Neuroscience, University of Cambridge, UK; Department of 
      Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung 
      University College of Medicine, Taoyuan, Taiwan.
FAU - Torheim, Turid
AU  - Torheim T
AD  - Cancer Research UK Cambridge Institute, University of Cambridge, UK; CRUK & EPSRC 
      Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK.
FAU - McLean, Mary A
AU  - McLean MA
AD  - Cancer Research UK Cambridge Institute, University of Cambridge, UK.
FAU - Boonzaier, Natalie R
AU  - Boonzaier NR
AD  - Developmental Imaging and Biophysics Section, Great Ormond Street Institute of 
      Child Health, University College London, UK.
FAU - Zou, Jingjing
AU  - Zou J
AD  - Statistical Laboratory, Centre for Mathematical Sciences, University of 
      Cambridge, UK.
FAU - Huang, Yuan
AU  - Huang Y
AD  - EPSRC Centre for Mathematical Imaging in Healthcare, University of Cambridge, UK; 
      Department of Radiology, University of Cambridge, UK.
FAU - Yuan, Jianmin
AU  - Yuan J
AD  - Department of Radiology, University of Cambridge, UK.
FAU - van Dijken, Bart R J
AU  - van Dijken BRJ
AD  - Department of Radiology, University Medical Center Groningen, University of 
      Groningen, the Netherlands.
FAU - Matys, Tomasz
AU  - Matys T
AD  - Statistical Laboratory, Centre for Mathematical Sciences, University of 
      Cambridge, UK; Cancer Trials Unit Department of Oncology, Addenbrooke's Hospital, 
      Cambridge, UK.
FAU - Markowetz, Florian
AU  - Markowetz F
AD  - Cancer Research UK Cambridge Institute, University of Cambridge, UK; CRUK & EPSRC 
      Cancer Imaging Centre in Cambridge and Manchester, Cambridge, UK.
FAU - Price, Stephen J
AU  - Price SJ
AD  - Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department 
      of Clinical Neuroscience, University of Cambridge, UK; Wolfson Brain Imaging 
      Centre, Department of Clinical Neuroscience, University of Cambridge, UK.
LA  - eng
GR  - C14303/A17197/CRUK_/Cancer Research UK/United Kingdom
GR  - C197/A16465/CRUK_/Cancer Research UK/United Kingdom
GR  - A19274/CRUK_/Cancer Research UK/United Kingdom
GR  - NIHR/CS/009/011/DH_/Department of Health/United Kingdom
GR  - 19274/CRUK_/Cancer Research UK/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190131
PL  - Ireland
TA  - Radiother Oncol
JT  - Radiotherapy and oncology : journal of the European Society for Therapeutic 
      Radiology and Oncology
JID - 8407192
RN  - YF1K15M17Y (Temozolomide)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Chemoradiotherapy
MH  - Cohort Studies
MH  - Diffusion Magnetic Resonance Imaging/methods
MH  - Female
MH  - Glioblastoma/*blood supply/*diagnostic imaging/drug therapy/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Magnetic Resonance Imaging/methods
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Invasiveness
MH  - Supratentorial Neoplasms/*blood supply/*diagnostic imaging/drug therapy/mortality
MH  - Survival Rate
MH  - Temozolomide/therapeutic use
MH  - Young Adult
PMC - PMC6486398
OTO - NOTNLM
OT  - Diffusion imaging
OT  - Glioblastoma
OT  - Heterogeneity
OT  - Perfusion imaging
OT  - Radioresistance
OT  - Tumor habitat imaging
EDAT- 2019/04/22 06:00
MHDA- 2020/03/28 06:00
PMCR- 2019/05/01
CRDT- 2019/04/22 06:00
PHST- 2018/09/27 00:00 [received]
PHST- 2018/12/10 00:00 [revised]
PHST- 2019/01/09 00:00 [accepted]
PHST- 2019/04/22 06:00 [entrez]
PHST- 2019/04/22 06:00 [pubmed]
PHST- 2020/03/28 06:00 [medline]
PHST- 2019/05/01 00:00 [pmc-release]
AID - S0167-8140(19)30012-X [pii]
AID - 10.1016/j.radonc.2019.01.008 [doi]
PST - ppublish
SO  - Radiother Oncol. 2019 May;134:17-24. doi: 10.1016/j.radonc.2019.01.008. Epub 2019 
      Jan 31.