Figure 1.
Flow diagram of patient selection and inclusion and exclusion criteria.
Note– *DSC: dynamic susceptibility contrast, †IHC:immunohistochemistry.
Figure 2.
Clustering method was used as a semi-automatic segmentation of glioblastoma.
(A) Contrast-enhanced T1-weighted images were used as structural images. (B) Volume of interest (VOI) was determined by a neuroradiologist. (C, D) VOIs were divided into seven tissue classes according to pixel values and class 6 and 7 were selected as enhancing tumor tissue. (C: class 6, D: class 6 and 7 together).
Figure 3.
Box and whisker diagram displaying the relationship between normalized relative tumor blood volume (nTBV) and PTEN expression status in EGFR expression-positive group.
The EGFR expression-positive glioblastomas with PTEN loss showed statistically higher nTBV values than those without PTEN loss. Note– †nTBV: normalized relative tumor blood volume.
Table 1.
nTBV values according to genetic alterations.
Table 2.
Az values, sensitivities, and specificities of nTBV in predicting PTEN loss or MGMT methylation status of GBM.
Figure 4.
Box and whisker diagram displaying the relationship between normalized relative tumor blood volume (nTBV) and MGMT promoter methylation status.
The MGMT methylation-positive group showed statistically lower nTBV values than the MGMT methylation-negative group. Note– *MEth: MGMT promoter methylation, †nTBV: normalized relative tumor blood volume.
Figure 5.
Scatter diagram and regression line display the relationship between nTBV and Ki-67 labeling index.
There was strong positive correlation between the Ki-67 labeling index and nTBV. Note– *nTBV: normalized relative tumor blood volume.
Figure 6.
Scatter diagram and regression line display the relationship between nTBV and p53 index.
There was no significant correlation between p53 index and nTBV value. Note– *nTBV: normalized relative tumor blood volume.
Figure 7.
Glioblastomas with aggressive genetic profiles show high normalized relative tumor blood volume (nTBV).
(A, B) A 66-year-old woman had glioblastoma with EGFR expression (3+), PTEN loss (+), MGMT methylation (−), and a Ki-67 index of 39%. The tumor showed high nTBV (27.5).(C, D) A 70-year-old man had glioblastoma with EGFR expression (3+), PTEN loss (+), MGMT methylation (−), and a Ki-67 index of 27%. The tumor showed high nTBV (12.84). (A, C) Contrast-enhanced T1-weighted axial image, (B, D) normalized relative cerebral blood volume (nCBV) map overlaid on structural contrast-enhanced T1-weighted axial image.
Figure 8.
Glioblastomas with favorable genetic profiles show low normalized relative tumor blood volume (nTBV).
(A, B) A 67-year-old man had glioblastoma with EGFR expression (2+), PTEN loss (−), MGMT methylation (+), and a Ki-67 index of 5%. The tumor showed low nTBV (4.3). (C, D) A 36-year-old woman had glioblastoma with EGFR expression (+), PTEN loss (−), MGMT methylation (+), and a Ki-67 index of 9%. The tumor showed low nTBV (4.59) (A, C) Contrast-enhanced T1-weighted axial image, (B, D) normalized relative cerebral blood volume (nCBV) map overlaid on structural contrast-enhanced T1-weighted axial image.