Clinical Validation of Automatable Gaussian Normalized CBV in Brain Tumor Analysis: Superior Reproducibility and Slightly Better Association with Survival than Current Standard Manual Normal Appearing White Matter Normalization.
Clinical Validation of Automatable Gaussian Normalized CBV in Brain Tumor Analysis: Superior Reproducibility and Slightly Better Association with Survival than Current Standard Manual Normal Appearing White Matter Normalization.
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DOI：
10.1016/j.tranon.2018.07.017
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发表时间：
2018-12
影响因子：
5
通讯作者：
Young GS
中科院分区：
文献类型：
--
作者：
Qin L;Li X;Li A;Cheng S;Qu J;Reinshagen K;Hu J;Himes N;Lu G;Xu X;Young GS
目得：在新诊断的胶质母细胞瘤患者中，通过与总生存期（OS）的相关性验证高斯标准化脑血容量（GN-nCBV），并将该相关性与当前标准白色标准化脑血容量（WN-nCBV）进行比较。方法：我们检索了2006年至2011年期间51例新诊断的胶质母细胞瘤成人患者（28例男性，23例女性;年龄23-87岁）在最大切除术后和放疗前获得的自旋回波平面动态磁敏感对比MRI。内部开发软件代码，以将CBV高斯归一化为全脑CBV的标准差。三位专家阅片员手动选择CBV图上肿瘤和正常白色物质中的感兴趣区域。计算GN-nCBV和WN-nCBV的nCBV与15个月OS相关的受试者工作特征（ROC）曲线。使用受试者内变异系数（wCV）和组内相关系数（ICC）比较了再现性和操作者变异性。结果：GN-nCBV ICC（≥0.82）和wCV（≤21%）上级WN-nCBV ICC（0.54-0.55）和wCV（≥46%）。ROC曲线下面积分析表明，GN-nCBV和WN-nCBV均能很好地预测OS，但GN-nCBV始终具有上级优势，尽管差异无统计学意义。结论：在我们的胶质母细胞瘤患者队列中，GN-nCBV与临床金标准OS的相关性略好于传统WM-nCBV。这种等效或上级的有效性，结合更高的可重复性，更低的操作者变异性和更容易自动化的优点，使得GN-nCBV上级WM-nCBV用于神经胶质瘤患者的临床和研究。我们建议广泛采用GN-nCBV并将其纳入商业动态磁化率对比处理软件。
PURPOSE: To validate Gaussian normalized cerebral blood volume (GN-nCBV) by association with overall survival (OS) in newly diagnosed glioblastoma patients and compare this association with current standard white matter normalized cerebral blood volume (WN-nCBV). METHODS: We retrieved spin-echo echo-planar dynamic susceptibility contrast MRI acquired after maximal resection and prior to radiation therapy between 2006 and 2011 in 51 adult patients (28 male, 23 female; age 23-87 years) with newly diagnosed glioblastoma. Software code was developed in house to perform Gaussian normalization of CBV to the standard deviation of the whole brain CBV. Three expert readers manually selected regions of interest in tumor and normal-appearing white matter on CBV maps. Receiver operating characteristics (ROC) curves associating nCBV with 15-month OS were calculated for both GN-nCBV and WN-nCBV. Reproducibility and interoperator variability were compared using within-subject coefficient of variation (wCV) and intraclass correlation coefficients (ICCs). RESULTS: GN-nCBV ICC (≥0.82) and wCV (≤21%) were superior to WN-nCBV ICC (0.54-0.55) and wCV (≥46%). The area under the ROC curve analysis demonstrated both GN-nCBV and WN-nCBV to be good predictors of OS, but GN-nCBV was consistently superior, although the difference was not statistically significant. CONCLUSION: GN-nCBV has a slightly better association with clinical gold standard OS than conventional WM-nCBV in our glioblastoma patient cohort. This equivalent or superior validity, combined with the advantages of higher reproducibility, lower interoperator variability, and easier automation, makes GN-nCBV superior to WM-nCBV for clinical and research use in glioma patients. We recommend widespread adoption and incorporation of GN-nCBV into commercial dynamic susceptibility contrast processing software.
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