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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1807738
Original Article

Prediction of Survival in Surgically Treated Glioblastoma Multiforme Utilizing DTI and Contrast-Enhanced MRI

Akhil Thomas
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar India
,
Mainak Sinha 
2   Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar India
,
Subhash Kumar 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar India
,
Anand K. Das
3   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar India
,
Saraj K. Singh
3   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar India
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Abstract

Introduction Glioblastoma multiforme (GBM) is a highly malignant brain tumor with poor prognosis, despite maximal safe resection and chemoradiotherapy. Predicting survival outcomes is crucial for optimizing treatment strategies. While conventional magnetic resonance imaging (MRI) reveals tumor characteristics, advanced sequences like diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) may enhance prognostic accuracy.

Materials and Methods A retrospective study reviewed 45 newly diagnosed GBM patients treated with maximal safe resection, adjuvant radiotherapy, and temozolomide between 2016 and 2022. Preoperative MRI data, including conventional sequences, DTI, and SWI, were analyzed. Radiological parameters—tumor volume, edema:tumor volume ratio, necrosis, enhancement, fractional anisotropy (FA), and microhemorrhage—were assessed for survival prediction. Kaplan–Meier survival analysis and Cox regression evaluated their prognostic significance.

Results Among the 45 patients, the median follow-up was 58.3 weeks, with 30 deaths reported. Significant differences were observed in FA, edema:tumor volume ratio, necrosis, enhancement, and microhemorrhage between survivors and nonsurvivors. Higher edema:tumor volume ratio (cutoff ≥ 0.905, area under the curve [AUC] = 0.895) and higher FA (cutoff ≥ 0.655, AUC = 0.8) correlated with mortality and survival, respectively. Multivariate Cox regression identified edema:tumor volume ratio (hazard ratio [HR] = 7.4, p < 0.05) and microhemorrhage > 25% (HR = 45.9, p < 0.05) as independent predictors of mortality.

Conclusion Tumor-related edema and necrosis significantly influence mortality, with edema:tumor volume ratio emerging as a stronger predictor than individual tumor or edema volumes. FA values reflect tumor aggressiveness, correlating with survival. Incorporating advanced imaging parameters like DTI and SWI alongside conventional MRI enhances prognostic precision in GBM management.

Keywords

DTI - edema:tumor volume ratio - glioblastoma multiforme - microhemorrhage - survival

Note

Presented at Organization – NSICON 2023 (71st Annual Conference of Neurological Society of India); Place – Bhubaneswar; Date: December 17, 2023.


Authors' Contributions

A.T. contributed to the conceptualization and design of the study, defining the intellectual content, conducting the literature search, performing clinical and experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, and is a guarantor of the study.

M.S. contributed to the literature search, performing experimental studies, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, and is a guarantor of the study.

S.K. contributed to the conceptualization and design of the study, defining the intellectual content, performing clinical studies, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review, and is a guarantor of the study.

A.K.D. contributed to the conceptualization and design of the study, defining the intellectual content, performing clinical studies, data acquisition, manuscript editing, and manuscript review.

S.K.S contributed to the conceptualization and design of the study, performing clinical studies, data acquisition, data analysis, manuscript preparation, manuscript editing, manuscript review, and is a guarantor of the study.




Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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