Introduction: High-grade gliomas (HGGs) are challenging to treat and often have poor prognoses and low survival rates. Advanced imaging techniques, like dynamic susceptibility contrast MRI (DSC-MRI) and dynamic contrast-enhanced MRI (DCE-MRI), have emerged as valuable tools in surgical planning and therapeutic management. These techniques aid in increased resection of active tumor areas, which can impact patient quality of life and survival.
Methods: A prospective, single-center study of HGG patients, including grade 3 astrocytoma and glioblastoma, who underwent surgery guided by preoperative and intraoperative MR imaging was performed. Cerebral blood volume (CBV), flow (CBF), and extent of resection (EOR) were compared with patient complications and quality of life (QoL) metrics via MDASI and FACT questionnaires. Patients were also analyzed after dividing by median overall survival (OS, 10 months).
Results: A total of 14 patients (mean age: 52.2, 35.7% male), including 3 isocitrate dehydrogenase 1/2 (IDH1/2) mutant and 11 IDH1/2 wild-type cases, were studied. An OS and progression-free survival (PFS) of 27±15 months (p=0.002) and 21±20 months (p=0.05) were respectively seen for patients with good outcomes. A mean EOR of 96±5% was seen during intraoperative MRIs, and there was no difference in EOR in patients with good or poor survival. Perfusion analysis showed significantly lower CBF in the good outcome group (4.95 ± 1.54 mL) compared to the poor outcome group (8.54 ± 3.56 mL) (p = 0.02). Patients with worse OS and PFS showed a significant decline in 3-month QoL metrics, especially within social/family well-being domains, that preceded Karnofsky Performance Status changes.
Conclusion : Advanced MR imaging and quantitative QoL measurements may help predict long term survival for patients with HGG. Improved sensitivity of these imaging and non-invasive metrics could be useful to monitor patients.
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