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Research ArticleAdult Brain
Open Access

Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab

N. Bahrami, D. Piccioni, R. Karunamuni, Y.-H. Chang, N. White, R. Delfanti, T.M. Seibert, J.A. Hattangadi-Gluth, A. Dale, N. Farid and C.R. McDonald
American Journal of Neuroradiology June 2018, 39 (6) 1017-1024; DOI: https://doi.org/10.3174/ajnr.A5620
N. Bahrami
aFrom the Center for Multimodal Imaging and Genetics (N.B., N.W., C.R.M.)
bDepartment of Psychiatry (N.B., Y.-H.C., C.R.M.)
cDepartment of Radiology (N.B., N.W., R.D., A.D., N.F., C.R.M.)
dMultimodal Imaging Laboratory (N.B., N.W., A.D., C.R.M.)
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D. Piccioni
eDepartment of Neurosciences (D.P., A.D., N.F.)
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R. Karunamuni
fDepartment of Radiation Medicine (R.K., T.M.S., J.A.H.-G.), University of California, San Diego, La Jolla, California.
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Y.-H. Chang
bDepartment of Psychiatry (N.B., Y.-H.C., C.R.M.)
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N. White
aFrom the Center for Multimodal Imaging and Genetics (N.B., N.W., C.R.M.)
cDepartment of Radiology (N.B., N.W., R.D., A.D., N.F., C.R.M.)
dMultimodal Imaging Laboratory (N.B., N.W., A.D., C.R.M.)
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R. Delfanti
cDepartment of Radiology (N.B., N.W., R.D., A.D., N.F., C.R.M.)
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T.M. Seibert
fDepartment of Radiation Medicine (R.K., T.M.S., J.A.H.-G.), University of California, San Diego, La Jolla, California.
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J.A. Hattangadi-Gluth
fDepartment of Radiation Medicine (R.K., T.M.S., J.A.H.-G.), University of California, San Diego, La Jolla, California.
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A. Dale
dMultimodal Imaging Laboratory (N.B., N.W., A.D., C.R.M.)
eDepartment of Neurosciences (D.P., A.D., N.F.)
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N. Farid
cDepartment of Radiology (N.B., N.W., R.D., A.D., N.F., C.R.M.)
eDepartment of Neurosciences (D.P., A.D., N.F.)
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C.R. McDonald
aFrom the Center for Multimodal Imaging and Genetics (N.B., N.W., C.R.M.)
bDepartment of Psychiatry (N.B., Y.-H.C., C.R.M.)
cDepartment of Radiology (N.B., N.W., R.D., A.D., N.F., C.R.M.)
dMultimodal Imaging Laboratory (N.B., N.W., A.D., C.R.M.)
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    Fig 1.

    A 58-year-old man's MR imaging post-subtotal resection with low edge contrast. The patient had a poor survival estimation, with a PFS of 1.8 months and OS of 7.3 months. A, FLAIR prebevacizumab. B, T1 postcontrast prebevacizumab. C, FLAIR postbevacizumab. D, T1 postcontrast postbevacizumab. E, Overlay of the EC contour over the postbevacizumab FLAIR image. F, 3D presentation of the surface of the hyperintense region. Darker areas on the surface indicate lower EC/more indistinct border, whereas the lighter areas toward red show higher EC/more distinct border.

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    Fig 2.

    A 60-year-old woman's MR imaging post-subtotal resection with high edge contrast. The patient had a high survival estimation with PFS of 11.5 months and OS of 13.6 months. A, FLAIR prebevacizumab. B, T1 postcontrast prebevacizumab. C, FLAIR postbevacizumab. D, T1 postcontrast postbevacizumab. E, Overlay of the EC contour over the postbevacizumab FLAIR image. F, 3D presentation of the surface of the hyperintense region. Darker areas on the surface indicate lower EC and more indistinct border, whereas the lighter areas toward red show higher EC and more distinct border.

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    Fig 3.

    Stratification of patients based on MSRS analysis for splits in post-EC100%. Kaplan-Meier curves for high and low change groups for PFS (A) and OS (B).

Tables

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    Table 1:

    Summary of the imaging parameters pre- and postbevacizumab

    ParameterPrebevacizumab Mean (SD) × 103Postbevacizumab Mean (SD) × 103P Value (T Value)
    EC100%2.52 (0.57)2.43 (0.57).256 (1.15)
    EC75%1.91 (0.53)1.77 (0.47).281 (1.08)
    EC50%1.51 (0.48)1.38 (0.40).277 (1.11)
    EC25%1.06 (0.38)0.98 (0.30).184 (1.35)
    FLAIRVOLa121.88 (70.68)77.317 (38.55).002 (4.28)
    CEVOLa24.90 (15.26)9.16 (9.17)<.001 (6.34)
    • ↵a P < .05.

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    Table 2:

    Summary of the multivariate CPH models with age and surgical extent (subtotal, gross total resection) as covariates

    EdgeTimePFS P ValueHR95% CIOS P ValueHR95% CI
    EC100%Postbevacizumab.009a0.370.18–0.78.046b0.420.18–0.98
    EC75%Postbevacizumab.013b0.330.13–0.79.041b0.340.12–0.96
    EC50%Postbevacizumab.015b0.290.10–0.78.026b0.250.07–0.85
    EC25%Postbevacizumab.018b0.210.05–0.77.022b0.160.03–0.77
    FLAIRVOLPostbevacizumab.8721.0001.000–1.000.2041.0001.000–1.000
    CEVOLPostbevacizumab.7581.0001.000–1.000.2581.0001.000–1.000
    ΔEC100%Pre- and postbevacizumab.018b2.811.92–6.65.033b2.981.09–8.16
    ΔEC75%Pre- and postbevacizumab.039b2.751.05–7.19.0503.060.99–9.39
    ΔEC50%Pre- and postbevacizumab.0582.910.96–8.08.0543.540.97–12.88
    ΔEC25%Pre- and postbevacizumab.0673.740.090–15.42.0564.760.95–23.64
    ΔFLAIRVOLPre- and postbevacizumab.3601.0001.000–1.000.4871.0001.000–1.000
    ΔCEVOLPre- and postbevacizumab.9511.0001.000–1.000.9261.0001.000–1.000
    • Note:—CPH indicates Cox proportional hazards; HR, hazard ratio.

    • ↵a P < .01.

    • ↵b P < .05.

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American Journal of Neuroradiology: 39 (6)
American Journal of Neuroradiology
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N. Bahrami, D. Piccioni, R. Karunamuni, Y.-H. Chang, N. White, R. Delfanti, T.M. Seibert, J.A. Hattangadi-Gluth, A. Dale, N. Farid, C.R. McDonald
Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab
American Journal of Neuroradiology Jun 2018, 39 (6) 1017-1024; DOI: 10.3174/ajnr.A5620

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Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab
N. Bahrami, D. Piccioni, R. Karunamuni, Y.-H. Chang, N. White, R. Delfanti, T.M. Seibert, J.A. Hattangadi-Gluth, A. Dale, N. Farid, C.R. McDonald
American Journal of Neuroradiology Jun 2018, 39 (6) 1017-1024; DOI: 10.3174/ajnr.A5620
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