Diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted imaging of the non-enhancing peritumoral region predict overall survival in glioblastoma

Abstract Purpose To investigate the predictive value of diffusion-weighted imaging (DWI) and dynamic sensitive contrast perfusion-weighted imaging (DSC-PWI) parameters based on contrast-enhancing regions (CER) and non-enhancing peritumoral regions (NEPR) for overall survival (OS) in patients with IDH wild-type glioblastoma (GBM) after gross-total resection (GTR). Methods Adult patients with IDH wild-type GBM who underwent GTR and were histologically confirmed at our institution were retrospectively collected and followed up. Patients were categorized into two groups, short-term survivors (STS; OS ≦ 16 months, n = 33) and long-term survivors (LTS; OS > 16 months, n = 28). The relative minimum apparent diffusion coefficient (rADCmin-t, rADCmin-p) and relative maximum cerebral blood volume (rCBVmax-t, rCBVmax-p) in the CER and NEPR were measured and analyzed via independent samples t-test, ROC curves, and Spearman correlation. Results 61 patients were included, with 33 in the STS group (mean age: 59.55 ± 10.24 years, 21 males) and 28 in the LTS group (mean age: 54.96 ± 11.60 years, 19 males). Compared with the LTS, STS demonstrated lower rADCmin-p (1.35 ± 0.27 vs. 1.80 ± 0.32, p < 0.001) and higher rCBVmax-p (4.46 ± 2.34 vs. 2.17 ± 0.85, p < 0.001). The AUCs of rADCmin-p and rCBVmax-p for OS prediction were 0.856 and 0.832, respectively, with the combined models achieving the highest AUC (0.909, p >0.05). In contrast, there was no significant difference in rADCmin-t and rCBVmax-t of CER between the two groups (both p > 0.05). Conclusion Preoperative rADCmin-p and rCBVmax-p in NEPR serve as crucial imaging markers for predicting OS in patients with IDH-wildtype GBM after GTR.