Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency.
Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency.
复制标题
DOI：
10.1227/neu.0000000000000892
复制
发表时间：
2015-10
期刊：
影响因子：
4.8
通讯作者：
Huston J
中科院分区：
文献类型：
--
作者：
Hughes JD;Fattahi N;Van Gompel J;Arani A;Meyer F;Lanzino G;Link MJ;Ehman R;Huston J
磁共振弹性成像（MRE）分析剪切波通过组织的运动，以确定刚度。在之前的研究中，使用第一代脑MRE技术的测量结果与术中观察到的脑膜瘤总体硬度相关。我们评估了与外科医生评估相比，高分辨率MRE技术在术前检测肿瘤内变异方面的诊断准确性。14例患者中的15例脑膜瘤接受了MRE。具有明显不同硬度区域的肿瘤被认为是异质性的。如果存在≥ 6千帕的显著区域，则认为瘤内部分较硬。采用5分量表对术中一致性进行分级。硬度计半定量测量手术标本硬度。统计包括卡方、敏感性、特异性、阳性和阴性预测值（PPV和NPV）以及斯皮尔曼等级相关系数。在MRE和手术之间，分别有9例（60%）和7例（47%）肿瘤是同质的; 6例（40%）和8例（53%）肿瘤是异质的; 6例（40%）和10例（67%）肿瘤有硬部分; 14例（93%）和12例（80%）肿瘤有软部分。MRE的敏感性、特异性、PPV和NPV分别为：异质性为75%、100%、100%和87%;硬度为60%、100%、100%和56%;柔软度为100%、33%、86%和100%。总体而言，10例（67%）肿瘤与MRE和术中一致性匹配良好，并且术中观察结果（p=0.018）与硬度计读数（p=0.046）相关。肿瘤大小≤ 3.5cm或血管性肿瘤更可能不一致（p<0.05）。MRE在排除具有硬部分的异质性方面非常出色，但在排除异质性和硬部分方面效果较差，特别是在血管较多或<3.5 cm的肿瘤中。磁共振成像是第一种能够前瞻性评估瘤内硬度的技术，经过进一步改进，可能会在术前计划中发挥作用。
Magnetic Resonance Elastography (MRE) analyzes shear waves’ movement thorough tissue to determine stiffness. In a prior study, measurements using first-generation brain MRE techniques correlated with intraoperative observations regarding overall meningioma stiffness. We evaluated the diagnostic accuracy of a higher-resolution MRE technique to preoperatively detect intratumoral variations as compared to surgeon assessment. Fifteen meningiomas in fourteen patients underwent MRE. Tumors with regions of distinctly different stiffness were considered heterogenous. Intratumoral portions were considered hard if there was a significant area ≥ 6 kiloPascals. A 5-point scale graded intraoperative consistency. A durometer semi-quantitatively measured surgical specimen hardness. Statistics included Chi-squared, sensitivity, specificity, positive and negative predicative values (PPV and NPV), and Spearman’s rank correlation coefficient. Between MRE and surgery respectively, 9(60%) vs 7(47%) tumors were homogenous; 6(40%) vs 8(53%) tumors were heterogenous; 6(40%) vs 10(67%) tumors had hard portions; and 14(93%) vs 12(80%) tumors had soft portions. MRE sensitivity, specificity, PPV and NPV were: for heterogeneity, 75%, 100%, 100%, and 87%; for hardness, 60%, 100%, 100%, and 56%; and for softness, 100%, 33%, 86%, and 100%. Overall, 10(67%) tumors matched well with MRE and intraoperative consistency and correlated between intraoperative observations (p=0.018) and durometer readings (p=0.046). Tumor size ≤3.5 cm or vascular tumors were more likely to be inconsistent (p<0.05). MRE was excellent at ruling-in heterogeneity with hard portions, but less effective in ruling-out heterogeneity and hard portions, particularly in tumors more vascular or <3.5 cm. MRE is the first technology capable of prospectively evaluating intratumoral stiffness and, with further refinement, will likely prove useful in preoperative planning.