Improved detection of diffuse glioma infiltration with imaging combinations: a diagnostic accuracy study
Improved detection of diffuse glioma infiltration with imaging combinations: a diagnostic accuracy study
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DOI：
10.1093/neuonc/noz180
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发表时间：
2020-03-01
期刊：
影响因子：
15.9
通讯作者：
Hamer, Philip C. de Witt
中科院分区：
文献类型：
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作者：
Verburg, Niels;Koopman, Thomas;Hamer, Philip C. de Witt
背景资料。弥漫性胶质瘤的手术切除和放疗由标准MRI指导：T2/液体衰减反转恢复(FLAIR)加权MRI用于平扫，T1加权Gd增强(T1G)用于强化胶质瘤。氨基酸PET已被建议作为新的标准。成像组合可能会提高标准MRI和氨基酸PET的准确性，本研究的目的是确定成像组合检测脑胶质瘤浸润性病变的准确性。我们包括20例新诊断的非增强型胶质瘤(7例弥漫性星形细胞瘤，异柠檬酸脱氢酶[IDH]突变；1例少突胶质瘤，IDH突变，1p/19q缺失；1例胶质母细胞瘤，IDH野生型)或增强型胶质瘤(胶质母细胞瘤，9例IDH野生型，2例IDH突变)。标准化的术前成像(T1、T2、FLAIR加权和T1GMRI、灌注和弥散磁共振、磁共振波谱和O-(2-[F-18]-氟乙基)-L-酪氨酸([F-18]FET)PET)与多区域立体定向活检在术前共定位。活检组织中肿瘤的存在由两位神经病理学家进行评估。通过接收器工作特性分析来确定诊断的准确性。共获得174例活检(其中63例来自9个非强化的胶质瘤，111个来自11个强化的胶质瘤)，其中129个含有肿瘤(50个来自非强化的胶质瘤，79个来自强化的胶质瘤)。在增强方面，表观扩散系数(ADC值)和[F-18]FETPET(曲线下面积[AuC]，95%CI：0.89，0.79~0.99)联合应用对肿瘤的诊断优于T1GMRI(0.56，0.39~0.72；P<；0.001)和[F-18]FETPET(0.76，0.66~0.86；P=0.001)。在无强化的胶质瘤中，没有一种成像组合对肿瘤的诊断明显好于标准MRI。FLAIR加权成像的AUC值为0.81(0.65~0.98)，而[F-18]FET PET的AUC值为0.69(0.56~0.81；P<0.019)。结合ADC和[F-18]FET PET在增强胶质瘤方面比标准MRI和[F-18]FET PET能更好地检测胶质瘤的浸润性，潜在地能够更好地指导局部治疗。
Background. Surgical resection and irradiation of diffuse glioma are guided by standard MRI: T2/fluid attenuated inversion recovery (FLAIR)-weighted MRI for non-enhancing andT1-weighted gadolinium-enhanced (T1G) MRI for enhancing gliomas. Amino acid PET has been suggested as the new standard. Imaging combinations may improve standard MRI and amino acid PET The aim of the study was to determine the accuracy of imaging combinations to detect glioma infiltration.Methods. We included 20 consecutive adults with newly diagnosed non-enhancing glioma (7 diffuse astrocytomas, isocitrate dehydrogenase [IDH] mutant; 1 oligodendroglioma, IDH mutant and 1p/19q codeleted; 1 glioblastoma IDH wildtype) or enhancing glioma (glioblastoma, 9 IDH wildtype and 2 IDH mutant). Standardized preoperative imaging (T1-, T2-, FLAIR-weighted, and T1G MRI, perfusion and diffusion MRI, MR spectroscopy and O-(2-[F-18]-fluoroethyl)-L-tyrosine ([F-18]FET) PET) was co-localized with multiregion stereotactic biopsies preceding resection. Tumor presence in the biopsies was assessed by 2 neuropathologists. Diagnostic accuracy was determined using receiver operating characteristic analysis.Results. A total of 174 biopsies were obtained (63 from 9 non-enhancing and 111 from 11 enhancing gliomas), of which 129 contained tumor (50 from non-enhancing and 79 from enhancing gliomas). In enhancing gliomas, the combination of apparent diffusion coefficient (ADC) with [F-18]FET PET (area under the curve [AUC], 95% CI: 0.89, 0.79-0.99) detected tumor better than T1G MRI (0.56, 0.39-0.72; P < 0.001) and [F-18]FET PET (0.76, 0.66-0.86; P = 0.001). In non-enhancing gliomas, no imaging combination detected tumor significantly better than standard MRI. FLAIR-weighted MRI had an AUC of 0.81 (0.65-0.98) compared with 0.69 (0.56-0.81; P. 0.019) for [F-18]FET PET.Conclusion. Combining ADC and [F-18]FET PET detects glioma infiltration better than standard MRI and [F-18]FET PET in enhancing gliomas, potentially enabling better guidance of local therapy.