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Research ArticleBrain
Open Access

Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma

F.E. Valles, C.L. Perez-Valles, S. Regalado, R.F. Barajas, J.L. Rubenstein and S. Cha
American Journal of Neuroradiology January 2013, 34 (1) 35-40; DOI: https://doi.org/10.3174/ajnr.A3165
F.E. Valles
aFrom the Departments of Radiology and Biomedical Imaging (F.E.V., C.L.P.-V., S.R., R.F.B., S.C.)
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C.L. Perez-Valles
aFrom the Departments of Radiology and Biomedical Imaging (F.E.V., C.L.P.-V., S.R., R.F.B., S.C.)
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S. Regalado
aFrom the Departments of Radiology and Biomedical Imaging (F.E.V., C.L.P.-V., S.R., R.F.B., S.C.)
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R.F. Barajas
aFrom the Departments of Radiology and Biomedical Imaging (F.E.V., C.L.P.-V., S.R., R.F.B., S.C.)
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J.L. Rubenstein
bMedicine, Division of Hematology/Oncology (J.L.R.), University of California San Francisco School of Medicine, San Francisco, California.
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S. Cha
aFrom the Departments of Radiology and Biomedical Imaging (F.E.V., C.L.P.-V., S.R., R.F.B., S.C.)
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    Fig 1.

    Overall survival and progression-free survival probability based on ADC or rCBV measurements. A and D, Patient outcome as a function of ADCmin stratification into low and high groups. Kaplan-Meier analysis (A) of OS for patients stratified into the low group (ADCmin < 384, dashed line) with a mean survival of 12.1 months versus those stratified into the high group (ADCmin ≥ 384, solid line) with a mean survival time of 20.1 months (P = .02, logrank test). Kaplan-Meier plot (D) of PFS stratified into the same low group (ADCmin < 384, dashed line) with a mean progression time of 13.8 months versus those stratified into the high group (ADCmin ≥ 384, solid line) with a mean progression time of 38.9 months (P < .01, logrank test). B and E, Patient outcome as a function of rCBVmean shows a statistically significant difference in OS and PFS between low (rCBVmean < 1.43) and high (rCBVmean ≥ 1.43) groups (P = .03, logrank test for OS; P = .03, logrank test for PFS). C and F, Patient outcome as a function of rCBVmin shows a statistically significant difference in OS and PFS between low (rCBVmin < 0.56) and high (rCBVmin ≥ 0.56) groups (P = .01, logrank test for OS; P < .01, logrank test for PFS).

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    Fig 2.

    Overall survival and progression-free survival probability based on combined ADC and rCBV measurements. A and C, Patient outcome as a function of combined stratification by using ADCmin and rCBVmean. Patients stratified into the low-low group (ADCmin < 384, rCBVmean < 1.43; dashed line), high-high group (ADCmin ≥ 384, rCBVmean ≥ 1.43; solid line), and mixed (low ADCmin and high rCBVmean or high ADCmin and low rCBVmean; dotted line). Kaplan-Meier analysis (A) of OS shows decreased median survival for the low-low group of 7.9 months and a median survival of 36.0 months for the mixed group (P < .01, logrank test). Kaplan-Meier analysis (C) of PFS shows a median progression for the low-low group of 2.5 months and a median progression of 36 months for the mixed group (P < .01, logrank test). C and D, Patient outcome as a function of combined stratification by using ADCmin and rCBVmin: patients stratified into the low-low group (ADCmin < 384, rCBVmin < 0.56; dashed line), high-high group (ADCmin ≥ 384, rCBVmin ≥ 0.56; solid line), and mixed (low ADCmin and high rCBVmin or high ADCmin and low rCBVmin; dotted line). Kaplan-Meier analysis shows statistically significant differences between groups in overall survival and progression (P < .01, logrank test for OS; P < .01, logrank test for PFS).

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    Fig 3.

    Prognostic survival groups based on individual or combined imaging variables. Overall survival stratification based on ADCmin, rCBVmin, or combined ADCmin–rCBVmin is shown as a boxplot. The survival difference is most marked when comparing the combined low ADCmin–low rCBVmin (low-low) group and the high ADCmin–high rCBVmin (high-high). Similar results are obtained if rCBVmean is used instead of rCBVmin.

Tables

  • Figures
  • Patient demographics and imaging characteristics

    Patient No.Age (yr)/SexADCmin × 1012ADC GroupCEL (vol · cm3)Edema (vol · cm3)rCBVmeanrCBVmean GrouprCBVminrCBVmin Group
    180/M520High11.37108.631.02Low0.01Low
    260/M618High6.2629.371.43Low0.40Low
    370/F575High12.6296.001.38Low0.33Low
    458/M133Low49.10153.201.00Low0.50Low
    574/F213Low43.4099.301.42Low0.26Low
    659/F594High20.0472.431.17Low0.26Low
    753/F236Low6.9062.601.15Low0.25Low
    864/F631High6.3941.621.16Low0.52Low
    971/F279Low28.89152.691.01Low0.27Low
    1058/F660High18.80193.901.17Low0.34Low
    1176/M640High5.0026.102.82High0.18Low
    1288/M580High14.70112.602.76High1.19High
    1384/M620High14.1889.762.62High0.50Low
    1457/F528High13.9030.501.61High0.89High
    1564/M260Low39.45218.881.67High0.02Low
    1664/F718High11.9450.494.39High1.19High
    1787/F586High4.0691.712.37High0.55Low
    1868/F1010High8.4019.601.80High1.16High
    1974/M684High16.86130.901.79High0.22Low
    2030/M505High29.00186.104.21High1.29High
    2170/F233Low22.60102.201.90High0.02Low
    2283/F409High8.8594.841.97High0.38Low
    2368/M562High22.60115.201.60High0.95High
    2460/F737High3.0645.381.50High0.34Low
    2559/F318Low17.4856.361.72High0.59High
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American Journal of Neuroradiology: 34 (1)
American Journal of Neuroradiology
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Cite this article
F.E. Valles, C.L. Perez-Valles, S. Regalado, R.F. Barajas, J.L. Rubenstein, S. Cha
Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma
American Journal of Neuroradiology Jan 2013, 34 (1) 35-40; DOI: 10.3174/ajnr.A3165

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Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma
F.E. Valles, C.L. Perez-Valles, S. Regalado, R.F. Barajas, J.L. Rubenstein, S. Cha
American Journal of Neuroradiology Jan 2013, 34 (1) 35-40; DOI: 10.3174/ajnr.A3165
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