Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence
Perfusion MRI in the Evaluation of Suspected Glioblastoma Recurrence
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DOI：
10.1111/jon.12247
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发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Hattingen, Elke
中科院分区：
文献类型：
--
作者：
Blasel, Stella;Zagorcic, Andrea;Hattingen, Elke
目的治疗相关变化（TRC）通常模仿胶质母细胞瘤的肿瘤进展。标准化一线放化疗后局部脑血容量（rCBV）的增加可以区分肿瘤进展与TRC，但对于没有任何临床选择标准的患者，有关rCBV诊断准确性的信息有限。因此，我们的目的是评估 rCBV 是否可以区分 TRC 和肿瘤进展，而与先前的治疗和肿瘤进展次数无关。方法我们分析了 44 例经过 MR 形态学肿瘤进展的预处理胶质母细胞瘤中标准化为对侧白质的增强区域的平均和最大 rCBV。诊断（实际进展与 TRC）由组织病理学或临床/MRI 随访确定。我们进行了非参数检验、接受者操作特征 (ROC) 和 Kaplan-Meier 分析。结果发现 rCBV（平均值）（2.44 1.05 与 1.69 +/- .56，P < .03）和 rCBV（最大值）（3.40 +/- 1.25 与 2.21 +/-）在肿瘤进展 (N = 37) 和 TRC (N = 7) 之间存在显着差异。 .62，P < .0007)。 rCBV(max) 为 2.6 时，检测肿瘤进展的敏感性为 78%，特异性为 86%。 rCBV（平均值）和 rCBV（最大值）都不能预测患者的总生存期 (OS)。首次肿瘤进展和进一步肿瘤进展之间的 rCBV（平均值）和 rCBV（最大值）没有统计学差异。结论：rCBV（最大值）可区分未选择的复发性胶质母细胞瘤中的肿瘤进展和 TRC，但不能预测 OS。
PURPOSETreatment-related changes (TRC) often imitate tumor progression in glioblastomas. Increased regional cerebral blood volume (rCBV) can differentiate tumor progression from TRC after the standardized first-line radiochemotherapy, but information about diagnostic accuracy of rCBV for patients without any clinical selection criteria is limited. Therefore, we aimed to evaluate if rCBV can differentiate between TRC and tumor progression irrespective of preceding therapies and number of tumor progressions.METHODSWe analyzed mean and maximum rCBV from the enhancing areas normalized to the contralateral white matter in 44 pretreated glioblastomas with MR-morphological tumor progression. The diagnosis (real progression vs. TRC) was determined by histopathology or by clinical/MRI-follow-up. We performed nonparametric tests, receiver operating characteristics (ROC), and Kaplan-Meier analysis.RESULTSSignificant differences between tumor progression (N = 37) and TRC (N = 7) were found for rCBV(mean) (2.44 1.05 vs. 1.69 +/- .56, P < .03) and rCBV(max) (3.40 +/- 1.25 vs. 2.21 +/- .62, P < .0007). A rCBV(max) of 2.6 had 78% sensitivity and 86% specificity to detect tumor progression. Neither rCBV(mean) nor rCBV(max) was predictive for the patient overall survival (OS). There were no statistically different rCBV(mean) and rCBV(max) between the first and further tumor progressions.CONCLUSIONSThe rCBV(max) differentiates tumor progression from TRC in unselected recurrent glioblastomas, but it is not predictive for the OS.