Prognostic Prediction Based on Dynamic Contrast-Enhanced MRI and Dynamic Susceptibility Contrast-Enhanced MRI Parameters from Non-Enhancing, T2-High-Signal-Intensity Lesions in Patients with Glioblastoma

Abstract

Objective Few attempts have been made to investigate the prognostic value of dynamic contrast-enhanced (DCE) MRI or dynamic susceptibility contrast (DSC) MRI of non-enhancing, T2-high-signal-intensity (T2-HSI) lesions of glioblastoma multiforme (GBM) in newly diagnosed patients. This study aimed to investigate the prognostic values of DCE MRI and DSC MRI parameters from non-enhancing, T2-HSI lesions of GBM. Materials and Methods A total of 76 patients with GBM who underwent preoperative DCE MRI and DSC MRI and standard treatment were retrospectively included. Six months after surgery, the patients were categorized into early progression (n = 15) and non-early progression (n = 61) groups. We extracted and analyzed the permeability and perfusion parameters of both modalities for the non-enhancing, T2-HSI lesions of the tumors. The optimal percentiles of the respective parameters obtained from cumulative histograms were determined using receiver operating characteristic (ROC) curve and univariable Cox regression analyses. The results were compared using multivariable Cox proportional hazards regression analysis of progression-free survival. Results The 95th percentile value (PV) of Ktrans, mean Ktrans, and median Ve were significant predictors of early progression as identified by the ROC curve analysis (area under the ROC curve [AUC] = 0.704, p = 0.005; AUC = 0.684, p = 0.021; and AUC = 0.670, p = 0.0325, respectively). Univariable Cox regression analysis of the above three parametric values showed that the 95th PV of Ktrans and the mean Ktrans were significant predictors of early progression (hazard ratio [HR] = 1.06, p = 0.009; HR = 1.25, p = 0.017, respectively). Multivariable Cox regression analysis, which also incorporated clinical parameters, revealed that the 95th PV of Ktrans was the sole significant independent predictor of early progression (HR = 1.062, p < 0.009). Conclusion The 95th PV of Ktrans from the non-enhancing, T2-HSI lesions of GBM is a potential prognostic marker for disease progression.

Apparent Diffusion Coefficient MRI Shows Association With Early Progression of Unresectable Intrahepatic Cholangiocarcinoma With Combined Targeted‐Immunotherapy

“…In this study, we used 12 months as the prognostic prediction endpoint for EP, instead of 6 months. 37,38 The main reason was because only 30% of our patients showed a disease progression within the first 6 months, while the majority (80%) progressed within 12 months. Thus, a 12-month cut-off was considered of more clinical prognostic value, but further investigation with larger sample size is valuable for validation.…”

“…In this study, we used 12 months as the prognostic prediction endpoint for EP, instead of 6 months 37,38 . The main reason was because only 30% of our patients showed a disease progression within the first 6 months, while the majority (80%) progressed within 12 months.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 28 original research studies reporting HR published in the Korean Journal of Radiology in 2020–2021 [ 11 15 32 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] were evaluated against a rigorous standard, 96.4% (27/28) explicitly defined the events for HR, 48.1% (13/27) unmistakably described the reference category for HR calculation for categorical variables, and only 50% (10/20) clearly described the one-unit amount for HR for continuous variables. Therefore, further improvements are required.…”

Mistakes to Avoid for Accurate and Transparent Reporting of Survival Analysis in Imaging Research

“…This approach [29,[33][34][35][36][37][38][39][40][41][42] may sound reasonable at a glance but is generally invalid. This analysis is logical only when the follow-up time is fixed and specified for the grouping of patients (e.g., patients developing events by 6 months after treatment vs. patients free of events until 6 months) and all patients have completely been followed until the specified time point (e.g., all have been followed until 6 months without dropouts unless they had events) [36][37][38]43]. Complete follow-up is difficult to achieve in clinical research, especially in retrospective studies or studies that involve long periods of follow-up.…”

“…Accordingly, this analytic approach is more reasonable if a study is looking for events that occur within relatively short periods. For example, one study [36] divided patients with glioblastoma multiforme into those who had early progression after treatment (i.e., progression before 6 months) and those who did not because the study had a specific purpose of finding factors associated with the early progression after the treatment. All study patients could be followed completely without dropouts as the follow-up period was relatively short.…”