Incorporating Supramaximal Resection into Survival Stratification of IDH-Wildtype Glioblastoma: A Refined Multi-institutional Recursive Partitioning Analysis.

PURPOSE: To propose a novel recursive partitioning analysis (RPA) classification model in patients with IDH-wildtype glioblastomas that incorporates the recently expanded conception of the extent of resection (EOR) in terms of both supramaximal and total resections. EXPERIMENTAL DESIGN: This multicenter cohort study included a developmental cohort of 622 patients with IDH-wildtype glioblastomas from a single institution (Severance Hospital) and validation cohorts of 536 patients from three institutions (Seoul National University Hospital, Asan Medical Center, and Heidelberg University Hospital). All patients completed standard treatment including concurrent chemoradiotherapy and underwent testing to determine their IDH mutation and MGMTp methylation status. EORs were categorized into either supramaximal, total, or non-total resections. A novel RPA model was then developed and compared to a previous RTOG RPA model. RESULTS: In the developmental cohort, the RPA model included age, MGMTp methylation status, KPS, and EOR. Younger patients with MGMTp methylation and supramaximal resections showed a more favorable prognosis (class I: median overall survival [OS] 57.3 months), while low-performing patients with non-total resections and without MGMTp methylation showed the worst prognosis (class IV: median OS 14.3 months). The prognostic significance of the RPA was subsequently confirmed in the validation cohorts, which revealed a greater separation between prognostic classes for all cohorts compared to the previous RTOG RPA model. CONCLUSIONS: The proposed RPA model highlights the impact of supramaximal versus total resections and incorporates clinical and molecular factors into survival stratification. The RPA model may improve the accuracy of assessing prognostic groups.

Comparison of dynamic susceptibility contrast (DSC) using gadolinium and iron-based contrast agents in high-grade glioma at high-field MRI.

PURPOSE: To compare DSC-MRI using Gadolinium (GBCA) and Ferumoxytol (FBCA) in high-grade glioma at 3T and 7T MRI field strengths. We hypothesized that using FBCA at 7T would enhance the performance of DSC, as measured by contrast-to-noise ratio (CNR). METHODS: Ten patients (13 lesions) were assigned to 3T (6 patients, 6 lesions) or 7T (4 patients, 7 lesions). All lesions received 0.1 mmol/kg of GBCA on day 1. Ten lesions (4 at 3T and 6 at 7T) received a lower dose (0.6 mg/kg) of FBCA, followed by a higher dose (1.0-1.2 mg/kg), while 3 lesions (2 at 3T and 1 at 7T) received only a higher dose on Day 2. CBV maps with leakage correction for GBCA but not for FBCA were generated. The CNR and normalized CBV (nCBV) were analyzed on enhancing and non-enhancing high T2W lesions. RESULTS: Regardless of FBCA dose, GBCA showed higher CNR than FBCA at 7T, which was significant for high-dose FBCA (p < .05). Comparable CNR between GBCA and high-dose FBCA was observed at 3T. There was a trend toward higher CNR for FBCA at 3T than 7T. GBCA also showed nCBV twice that of FBCA at both MRI field strengths with significance at 7T. CONCLUSION: GBCA demonstrated higher image conspicuity, as measured by CNR, than FBCA on 7T. The stronger T2* weighting realized with higher magnetic field strength, combined with FBCA, likely results in more signal loss rather than enhanced performance on DSC. However, at clinical 3T, both GBCA and FBCA, particularly a dosage of 1.0-1.2 mg/kg (optimal for perfusion imaging), yielded comparable CNR.

Correlation between the severity of hepatitis B cirrhosis and CT volumetry-based hepatic segmental anatomic changes.

OBJECTIVE: To study the correlation between the changes of hepatic segmental volumes and the severity of hepatitis B cirrhosis, classified by Child-Pugh score. MATERIAL AND METHOD: The study cohort comprised viral hepatitis B cirrhotic patients with different severity (Child-Pugh score grade A to C) and control subjects who underwent hepatic computed tomographic (CT) scan between February 2006 and May 2012. The volumes of total liver (TLV), right lobe (RV), left medial segment (LMV), left lateral segment (LLV), and caudate lobe (CV) were measured and compared between the control group and Child-Pugh A, B, and C groups. RESULTS: Among 120 hepatitis B cirrhotic subjects, there were 85 males (70.8%) with the mean age of 59.2 years (range 36-86 years). Sixty-two subjects were Child-Pugh A, 39 were Child-Pugh B, and 19 were Child-Pugh C. Among 62 control subjects, there were 28 males (45.2%) with the mean age of54.5 years (range 19-82 years). The TLVand R Vwere significantly decreased in Child-Pugh B and C subjects when compared with control subjects. LMV was significantly decreased in Child-Pugh A and continually decreased along with the severity of the disease. LLV was significantly increased in Child-Pugh A and B, but relative in Child-Pugh C subjects. CV was not significantly different in these four groups. CONCLUSION: Hepatitis B cirrhotic patients had progressive hepatic atrophy, initially by left medial segment, followed by right lobe and the whole liver Hypertrophy of left lateral segment was evident in early cirrhosis but not significantly shown in severe cirrhosis. Hypertrophy of caudate lobe was not evident in any degrees of hepatitis B cirrhosis.