AUTHOR=Yuan Tao , Gao Zhen , Wang Fei , Ren Jia-Liang , Wang Tianda , Zhong Hongbo , Gao Guodong , Quan Guanmin 

TITLE=Relative T2-FLAIR signal intensity surrounding residual cavity is associated with survival prognosis in patients with lower-grade gliomas

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.960917

DOI=10.3389/fonc.2022.960917

ISSN=2234-943X

ABSTRACT=Aims: To investigate whether the relative signal intensity surrounding residual cavity on T2-Fluid attenuated inversion recovery (rFLAIR) can improve survival prediction of lower grade gliomas (LGG) patients. 
Methods: Clinical and pathological data, and follow-up MR imaging of 144 patients with LGG were analyzed. We calculated rFLAIR with Image J software. Logistic analysis was used to explore the significant impact factors on progression free survival (PFS) and overall survival (OS). Several models were setup to predict survival prognosis of LGG. 
Results: Higher rFLAIR [1.81 (0.83)] [median (IQR)] of non-enhancing regions surrounding residual cavity was detected in progressed group (n=77) than that [1.55 (0.33)] [median (IQR)] of not-progressed group (n = 67) (P<0.001). Multivariate analysis showed that lower KPS (≤75), and higher rFLAIR (>1.622) were independent predictors for poor PFS (P＜0.05). Whereas, lower KPS (≤75), thick-linear and nodular enhancement were the independent predictors for poor OS (P＜0.05). The cut-off rFLAIR value of 1.622 could be used to predict poor PFS (HR = 0.31, 95%CI 0.20-0.48) (P<0.001) and OS (HR = 0.27，95%CI 0.14-0.51) (P=0.002). Both the areas under the ROC curve (AUCs) for predicting poor PFS (AUC, 0.771) and OS (AUC, 0.831) with combined model which contained rFLAIR were higher than those of any other models. 
Conclusion: Higher rFALIR (>1.622) in non-enhancing regions surrounding the residual cavity can be used as a biomarker of poor survival of LGG. rFLAIR is helpful to improve survival prediction of post-treatment LGG patients.