The Prognostic Value Of IVIM,ASL And DWI In One-year’s Progression-free Survival Of High-grade Gliomas

Object:The purpose of this study is to investigate the functional magnetic resonance imaging(3D-PCASL,conventional DWI and IVIM-DWI)and the clinical features in high grade gliomas patients,to find the predictive value of the 1 year progression-free survival,then comparing them to find out the independent prognostic factors.Methods:1.31 high grade gliomas patients were collected(15 male cases and 16 female cases),age range: 12-73 years old,with an average age of 53.1 years old,including14 WHO III cases and 17 WHO IV cases.1.All patients completed the conventional MRI sequence in 3.0T MR(T1WI T2 WI,DWI,T2FLAIR);IVIM-DWI、3D-PCASL and enhancement.2.Through the Function tool software of AW4.6 workstation,IVIM-DWI get the slow diffusion coefficient D(slow ADC),fast diffusion coefficient D*(fast ADC)and the fractional perfusion-related volume f value(fraction of fast ADC)images;conventional DWI obtain the diffusion coefficient ADC images;ASL get the cerebral blood flow(CBF)images.3.Combined the conventional MRI images with multi-direction enhanced T1 WI images,then selected the lowest D image of IVIM-DWI,the hyperperfusion region of ASL and the brightest area of DWI as the analysis region separately,manully drawing inrerested region three times in the tumor solid area.In ASL data processing,the region of interest(ROI)were also placed on the contralateral normal hemisphere and got the rCBF value.Avoiding the cystic,necrosis area and vascular area,the average size of each ROI is about 50mm2.4.All patients underwent complete or partial resection surgical of tumor,then underwent postoperative radiotherapy and adjuvant temozolomide chemotherapy.Follow-up MRI examination were conducted every 3 months after operation in all patients.The starting point of this study is tumor operation time,the end point istumor progression time or death time,or the last follow-up date(March 1,2017).Collecting the progression-free survival of all patients.5.Statistical analysis:(1)all tumor’s mean CBF,ADC,D,D* and f were analyzed by ROC curves,got the threshold,the sensitivity and specificity,then compared them with pathological grading.(2)The survival rate were calculated by Kaplan-Meier method,and used Log rank method to test the survival situation.(3)All the imaging parameters and clinical features were analyzed using Cox proportional hazards univariate and multivariate regression models.P<0.05 means difference was statistically significant in all statistical analysis.Results1.Clinical features:(1)The high grade glioma patients(31 cases): Male / female: 15/16 cases;age:12-73 years old,the average age were 53.1 years old;the complete surgical resection of the tumor / partial resection: 20/11;PFS were 63-732 days;1 years’ no progress /progress cases: 16/15.(2)WHO III(14 cases): Male / female: 6/8 cases;age: 30-67 years old;complete/ partial resection of tumor: 10/4 cases;PFS were 90-473 days;no progress /progression in the last 1 years: 8/6 cases(3)WHO IV(17 cases): Male / female: 9/8 cases;age: 12-73 years old;complete/ partial resection of the tumor: 10/7 cases;PFS were 63-732 days;no progress /progression in the last 1 years: 8/9 cases2.ROC curve analysis:(1)IVIM:(1)The Az of D* value was 0.602,the threshold was 3.28,the sensitivity and specificity were 86.7% and 50.0%,respectively.(2)The Az of D value was 0.725,the threshold was 0.522,the sensitivity and specificity were 66.7% and 87.5%,respectively.(3)The Az of f value was 0.708,the threshold was 0.408,the sensitivity and specificity were 86.7% and 62.5%,respectively.(2)ASL: The Az of rCBF value was 0.825,the threshold was 6.408,the sensitivity and specificity were 66.7% and 87.5%,respectively.(3)DWI: The Az of ADC value was 0.771,the threshold was 0.741,the sensitivity and specificity were 80.0% and 81.2%,respectively.3.Kaplan-Meier curve analysis:(1)IVIM:(1)If D*>3.28 ×10-3mm2/s,PFS has no significant difference(P=0.067).(2)If D≤0.522×10-3mm2/s,PFS decreased with significantly statistical difference(P=0.00004).(3)If f≤0.408,PFS decreased with significantly statistical difference(P=0.007).(2)ASL: If rCBF>6.408,PFS decreased with significantly statistical difference(P=0.003).(3)DWI: If ADC≤0.741×10-3mm2/s,PFS decreased with significantly statistical difference(P=0.00005).4.Univariate analysis of Cox regression model:(1)Clinical features:(1)The P values of gender and age were 0.086,0.072,HR were 2.570,1.046,95%CI were 0.876-7.542,0.996-1.099,respectively.(2)The P values of tumor resection and pathological grading were 0.0002,0.420,HR were 8.167,1.532,95%CI were 2.688-24.80,0.544-4.313,respectively.(2)IVIM:(1)The P values of D value and D* value were 0.0003,0.088,HR were0.134,3.676,95%CI were 0.044-0.404,0.826-16.36,respectively.(2)The P value of f was 0.018,HR was 0.164,95%CI was 0.037-0.731.(3)ASL: The P value of rCBF was 0.006,HR was 4.587,95%CI were1.552-13.563.(4)DWI: The P value of ADC value was 0.001,HR was 0.107,95%CI was0.029-0.388.5.Multivariate analysis of Cox regression model:(1)Clinical feature:The P value of complete resection of tumor was 0.023,HR was 4.582,95%CI was 1.233-17.025.(2)IVIM:(1)The P value of D was 0.620,HR was 0.617,95%CI was 0.091-4.166.(2)The P value of f was 0.006,HR was 0.080,95%CI was 0.013-0.490.(3)ASL: The P value of rCBF was 0.029,HR was 5.162,95%CI was1.180-22.57.(4)DWI: The P value of ADC was 0.081,HR was 0.132,95%CI was0.014-1.285.Conclusion:The rCBF value of ASL and f value of IVIM both are independent prognostic factors in one-year’s progression-free survival of high grade gliomas,however,the predictive efficiency of the rCBF value is the best(AUC=0.825,the threshold was6.408),and the predictive efficiency of the f value is the moderate(AUC=0.708),other images parameters are not independent prognostic factors.Therefore,among the three kinds of functional magnetic resonance imaging,ASL has the best predictive value of one-year’s progression-free survival in high grade gliomas.