Higher cerebral metabolic rate of oxygen derived from dynamic susceptibility contrast MRI is an independent predictor of poor survival in IDH-wildtype glioblastoma

Abstract

Purpose To evaluate the role of tumor oxygenation imaging parameters in predicting the overall survival (OS) of newly diagnosed isocitrate dehydrogenase (IDH)-wildtype glioblastoma patients. Methods This retrospective single-institution study included 236 patients with IDH-wildtype glioblastomas. ADC values were obtained from autosegmented tumor masks. The normalized relative cerebral blood volume (rCBV), relative cerebral metabolic rate of oxygen values (CMRO2), capillary transit time heterogeneity, and oxygen extraction fraction were also extracted from DSC imaging. Univariable and multivariable Cox analyses including age, sex, Karnofsky performance status (KPS), O-6-methylguanine-DNA methyltransferase<bold> (</bold>MGMT) promoter methylation status, extent of resection (EOR), and quantitative imaging parameters were performed. Results On univariable analysis, older age, lower KPS, MGMT promoter unmethylation, lesser EOR, higher 10th percentile of rCBV, and higher 10th percentile of CMRO2 were significantly associated with poor OS. On multivariable analysis, older age (hazard ratio [HR] = 1.03, P < 0.001), MGMT promoter unmethylation (HR = 1.55, P < 0.001), lesser EOR (HR = 1.94, P < 0.001), and higher 10th percentile of CMRO2 (HR = 1.03, P = 0.045) were independently associated with poor OS. Conclusions Higher 10th percentile of CMRO2 may predict dismal prognosis in IDH-wildtype glioblastoma patients independently of previously known clinical, molecular, and surgical prognostic factors.