Korean J Radiol.  2016 Feb;17(1):117-126. 10.3348/kjr.2016.17.1.117.

Pre-Operative Perfusion Skewness and Kurtosis Are Potential Predictors of Progression-Free Survival after Partial Resection of Newly Diagnosed Glioblastoma

• Paik W
• Kim HS
• Choi CG
• Kim SJ

• KMID: 2351171
• DOI: http://doi.org/10.3348/kjr.2016.17.1.117

Abstract

OBJECTIVE
To determine whether pre-operative perfusion skewness and kurtosis derived from normalized cerebral blood volume (nCBV) histograms are associated with progression-free survival (PFS) of patients after partial resection of newly diagnosed glioblastoma.
MATERIALS AND METHODS
A total of 135 glioblastoma patients who had undergone partial resection of tumor (resection of < 50% of pre-operative tumor volume or surgical biopsy) confirmed with immediate postsurgical MRI and examined with both conventional MRI and dynamic susceptibility contrast (DSC) perfusion MRI before the surgery were retrospectively reviewed in this study. They had been followed up post-surgical chemoradiotherapy for tumor progression. Using histogram analyses of nCBV derived from pre-operative DSC perfusion MRI, patients were sub-classified into the following four groups: positive skewness and leptokurtosis (group 1); positive skewness and platykurtosis (group 2); negative skewness and leptokurtosis (group 3); negative skewness and platykurtosis (group 4). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were performed to determine whether clinical and imaging covariates were associated with PFS or overall survival (OS) of these patients.
RESULTS
According to the Kaplan-Meier method, median PFS of group 1, 2, 3, and 4 was 62, 51, 39, and 41 weeks, respectively, with median OS of 82, 77, 77, and 72 weeks, respectively. In multivariable analyses with Cox proportional hazards regression, pre-operative skewness/kurtosis pattern (hazard ratio: 2.98 to 4.64; p < 0.001), Karnofsky performance scale score (hazard ratio: 1.04; p = 0.003), and post-operative tumor volume (hazard ratio: 1.04; p = 0.02) were independently associated with PFS but not with OS.
CONCLUSION
Higher skewness and kurtosis of nCBV histogram before surgery were associated with longer PFS in patients with newly diagnosed glioblastoma after partial tumor resection.

Keyword

Brain; Glioblastoma; Surgery; Chemoradiotherapy; Perfusion; Magnetic resonance imaging

MeSH Terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms/*mortality/pathology/*surgery
Chemoradiotherapy
Disease-Free Survival
Female
Glioblastoma/*mortality/pathology/*surgery
Humans
Image Interpretation, Computer-Assisted
Image Processing, Computer-Assisted
Kaplan-Meier Estimate
Magnetic Resonance Imaging/methods
Male
Middle Aged
Regression Analysis
Retrospective Studies
Statistical Distributions
Tumor Burden
Young Adult

Figure

• 

  Fig. 1 Example of group 1 patient with positive skewness and leptokurtosis. A. 45-year-old man with pathologically proven glioblastoma. Contrast-enhanced T1-weighted image showing contrast-enhancing mass in right frontal lobe. B. MR perfusion image showing increased nCBV in corresponding contrast-enhancing-lesion. C. Histogram derived from nCBV had positive skewness and leptokurtosis (skewness = 1.14, kurtosis = 4.32). nCBV = normalized cerebral blood volume

• 

  Fig. 2 Example of group 3 patient with negative skewness and leptokurtosis. A. 54-year-old man with pathologically proven glioblastoma. Contrast-enhanced T1-weighted image showing contrast-enhancing mass in right frontal lobe. B. MR perfusion image showing increased nCBV in corresponding contrast-enhancing-lesion. C. Histogram derived from nCBV had negative skewness and leptokurtosis (skewness = -0.76, kurtosis = 3.52). nCBV = normalized cerebral blood volume

• 

  Fig. 3 Example of group 4 patient with negative skewness and platykurtosis. A. 66-year-old woman with pathologically proven glioblastoma. Contrast-enhanced T1-weighted image showing contrast-enhancing mass in right frontal lobe. B. MR perfusion image showing increased nCBV in corresponding contrast-enhancing-lesion. C. Histogram derived from nCBV had negative skewness and platykurtosis (skewness = -0.05, kurtosis = 2.31). nCBV = normalized cerebral blood volume

• 

  Fig. 4 Kaplan-Meier survival curves of patients stratified by perfusion skewness and kurtosis for progression-free survival (A) and overall survival (B). Patients were stratified by histogram patterns of pre-operative tumors into those with positive skewness and leptokurtosis (group 1), those with positive skewness and platykurtosis (group 2), those with negative skewness and leptokurtosis (group 3), and those with negative skewness and platykurtosis (group 4). Progression-free survival and overall survival tended to be longer in group 1.

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