Intraoperative Dynamic Susceptibility Contrast-Enhanced MRI Does Not Predict Survival Following High-Grade Glioma Resection

Introduction: Dynamic Susceptibility Contrast-Enhanced MRI (DSC) may predict survival outcomes of patients with high-grade glioma (HGG). We characterize the predictive potential of DSC variables captured preoperatively and intraoperatively in a prospective clinical trial.

Methods: Patients with HGG underwent surgical resection based on preoperative DSC. Intraoperative DSC was obtained and used for further resection. Tissue samples were collected based on imaging. Analysis of perfusion parameters on overall survival (OS) or progression-free survival (PFS) was performed using Cox hazards models, receiver operating characteristic curves, and Kaplan-Meier survival analysis. Welch’s t-tests were used to compare means based on WHO Grade and the presence of IDH1-R132H, MGMT, and p53 mutations.

Results: A total of 20 patients (mean age = 51) were included. Tissue confirmation of HGG was found for all preoperative DSC studies. There was a significant difference in means for preoperative relative mean cerebral blood volume (pCBV) and flow (pCBF) based on WHO Grade (p=0.006, p=0.03). There was not a significant difference in means for IDH-R132H, MGMT, or p53 mutation status, though pCBF approached significance for IDH-R132H and MGMT (p=0.09, p=0.08). Intraoperatively obtained relative mean cerebral blood volume and flow were not found to be independently associated with OS or PFS.

Conclusion : Our results support that preoperative DSC MRI can inform clinicians about WHO grade prior to HGG resection thereby adding to traditional clinical predictive factors and other data obtained from multiparametric imaging. Intraoperative DSC MRI was not found to be predictive of OS or PFS in this study. This data may serve as a baseline for future studies comparing active tumors, radiation necrosis, and pseudoprogression.