Tumor recurrence versus treatment effects in glioma
Tumor recurrence versus treatment effects in glioma
复制标题
胶质瘤的肿瘤复发与治疗效果
作者：
Qian Xu;Qi Liu;H. Ge;Xinting Ge;Jiangfen Wu;J. Qu;K. Xu
背景：胶质瘤占原发脑肿瘤的90%以上。准确识别胶质瘤复发和治疗效果非常重要，因为它可以帮助确定是继续使用标准辅助化疗还是转向二线治疗以治疗复发。我们的目的是比较三维伪连续动脉自旋标记(3D-PCASL)技术和动态磁化率对比灌注磁共振成像(DSC-MRI)在区分胶质瘤复发和治疗相关效应方面的作用。方法：对29例既往脑胶质瘤患者行3D-PCASL和DSC-MRI检查，发现术后放疗野内病灶增大，同时行同步放化疗(CCRT)。根据病理分析或临床放射学随访，将患者分为肿瘤复发组(n = 17例)和治疗有效组(n = 12例)。采用3分标准(1 = 较差，2 = 中等，3 = 良好)评价灌注成像质量。两种技术的灌注成像质量评分采用Wilcoxon单样本检验进行比较。两组脑血流量(ASL-CBF)、相对脑血流量(ASL-rCBF、DSC-rCBF)、相对脑血容量(DSC-rCBV)采用Wilcoxon单样本检验进行定量分析。计算类内相关系数(ICC)统计量，以测试所有血流参数的感兴趣区(ROI)测量的读数内变异性。结果：3D-PCASL的成像质量评分高于DSC- = (P<0.01)。肿瘤复发组与治疗有效组之间的血流灌注参数差异有统计学意义。ASL-rCBF与DSC-rCBF值(r = 0.803)、ASL-rCBF与DSC-rCBV值(r = 0.763)、DSC-rCBF与DSC-rCBV(r = 0.907)呈显著正相关。采用受试者工作特征(ROC)曲线分析两组间血流参数的显着性。以1.110为临界值，ASL-rCBF显示ROC曲线下面积最大(AUC)。但不同AUC之间的差异无统计学意义。国际商会对ASLCBF(ICC = 0.9636)、动态磁化率对比脑血流量(ICC = 0.8508)和动态磁化率对比脑血容量(DSC = 0.8543)的ROI测量有很好的一致性。结论：3D-PCASL是一种可替代DSC-MRI的灌注方法，可用于区分胶质瘤的复发和治疗效果。3D-PCASL是一种非侵入性检查，比DSC-MRI显示更少的敏感伪影。
Background: Gliomas constitute over 90% of primary brain tumors. Accurate identification of glioma recurrence and treatment effects is important, as it can help determine whether to continue with standard adjuvant chemotherapy or to switch to a second-line therapy for recurrence. Our purpose is to compare three dimensional pseudo-continuous arterial spin labeling (3D-pcASL) technique and dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-MRI) for differentiation tumor recurrence from treatment-related effects in gliomas. Methods: Twenty-nine patients with gliomas previously who showed enlarged, contrast-enhancing lesions within the radiation field after surgery and concurrent chemoradiotherapy (CCRT) were assessed with 3D-pcASL and DSC-MRI. These patients were classified into 2 groups, tumor recurrence group (n = 17) and treatment effects group (n = 12), based on pathologic analysis or clinical-radiologic follow-up. The perfusion imaging quality was assessed using a 3-point scale (1 = poor imaging, 2 = moderate imaging, and 3 = good imaging). Comparison for perfusion imaging-quality score between the 2 techniques was performed with Wilcoxon one-sample test. Quantitative analyses were performed between the 2 groups with cerebral blood flow values (ASL-CBF), relative cerebral blood flow values (ASL-rCBF, DSC-rCBF), and relative cerebral blood volume values (DSC-rCBV) using Wilcoxon one-sample test. The intra-class correlation coefficient (ICC) statistics were calculated for testing intrareader variability in regions of interest (ROIs) measurement of all perfusion parameters. Results: The imaging-quality score of 3D-pcASL was higher than that of DSC-MRI (P = .01). The perfusion parameters between tumor recurrence group and treatment effects group had statistically significant differences. There was a significant correlation between ASL-rCBF and DSC-rCBF values (r = 0.803), between ASL-rCBF and DSC-rCBV values (r = 0.763), and between DSC-rCBF and DSC-rCBV (r = 0.907). A receiver operating characteristic (ROC) curve analysis was performed for significant results of perfusion parameters between the 2 groups. Using a cutoff value of 1.110, ASL-rCBF showed the maximum area under the ROC curve (AUC). However, there were no significant differences among different AUCs. The ICC demonstrated excellent agreement for ROIs measurements of ASL-CBF (ICC = 0.9636), dynamic susceptibility contrast- cerebral blood flow (DSC-CBF) (ICC = 0.8508), and dynamic susceptibility contrast-cerebral blood volume (DSC-CBV) (ICC = 0.8543). Conclusion: 3D-pcASL is an alternative perfusion method to DSC-MRI for the differentiation between tumor recurrence and treatment effects in gliomas. 3D-pcASL is noninvasive and shows fewer susceptibility artifacts than DSC-MRI.
影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G