Prognostic value of preoperative dynamic contrast-enhanced MRI perfusion parameters for high-grade glioma patients

The prognostic value of the dynamic contrast-enhanced (DCE) MRI perfusion and its histogram analysis-derived metrics is not well established for high-grade glioma (HGG) patients. The aim of this prospective study was to investigate DCE perfusion transfer coefficient (K-trans), vascular plasma volume fraction (v(p)), extracellular volume fraction (v(e)), reverse transfer constant (k(ep)), and initial area under gadolinium concentration time curve (IAUGC) as predictors of progression-free (PFS) and overall survival (OS) in HGG patients. Sixty-nine patients with suspected anaplastic astrocytoma or glioblastoma underwent preoperative DCE-MRI scans. DCE perfusion whole tumor region histogram parameters, clinical details, and PFS and OS data were obtained. Univariate, multivariate, and Kaplan-Meier survival analyses were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify perfusion parameters with the best differentiation performance. On univariate analysis, v(e) and skewness of v(p) had significant negative impacts, while k(ep) had significant positive impact on OS (P < 0.05). v(e) was also a negative predictor of PFS (P < 0.05). Patients with lower v(e) and IAUGC had longer median PFS and OS on Kaplan-Meier analysis (P < 0.05). K-trans and v(e) could also differentiate grade III from IV gliomas (area under the curve 0.819 and 0.791, respectively). High v(e) is a consistent predictor of worse PFS and OS in HGG glioma patients. v(p) skewness and k(ep) are also predictive for OS. K-trans and v(e) demonstrated the best diagnostic performance for differentiating grade III from IV gliomas.