Relative Cerebral Blood Volume Values to Differentiate High-Grade Glioma Recurrence from Posttreatment Radiation Effect: Direct Correlation between Image-Guided Tissue Histopathology and Localized Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging Measurements
Relative Cerebral Blood Volume Values to Differentiate High-Grade Glioma Recurrence from Posttreatment Radiation Effect: Direct Correlation between Image-Guided Tissue Histopathology and Localized Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging Measurements
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DOI：
10.3174/ajnr.a1377
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发表时间：
2009-03-01
影响因子：
3.5
通讯作者：
Heiserman, J. E.
中科院分区：
文献类型：
--
作者：
Hu, L. S.;Baxter, L. C.;Heiserman, J. E.
背景与目的：鉴别肿瘤生长与治疗后放射效应（PTRE）仍然是神经肿瘤学实践中的一个常见问题。据我们所知，准确区分这两种实体的有用阈值相对脑血容量（rCBV）并不存在。我们的前瞻性研究在手术切除MR成像病变时使用图像引导神经导航，直接将标本组织病理学与局部动态敏感性加权对比增强灌注MR成像（DSC）测量结果联系起来，并建立准确的rCBV阈值，以区分PTRE与肿瘤复发。术前接受多模式治疗的高级别胶质瘤（HGG）患者获得3T梯度回声DSC和对比增强立体定向t1加权图像。术中神经导航记录了从增强MR成像病变周围随机抽取的多个组织标本的立体定向位置。DSC和立体定向图像的共配准可以计算先前记录的标本位置内的局部rCBV。所有组织标本经组织病理学分类为肿瘤或PTRE，并与相应的rCBV值相关。所有rCBV值均采用预负荷造影剂给予t1加权泄漏校正，并采用基线减积分T2/T2*加权泄漏校正。结果：13名受试者共采集组织标本40份。PTRE组（n = 16） rCBV值在0.21 ~ 0.71之间，肿瘤（n = 24） rCBV值在0.55 ~ 4.64之间，8.3%的肿瘤rCBV值落在PTRE组范围内。阈值0.71优化了组织病理组的分化，敏感性为91.7%，特异性为100%。结论：使用DSC和我们描述的方案获得的rCBV测量值可以高度准确地区分HGG复发和PTRE。
BACKGROUND AND PURPOSE: Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence,MATERIALS AND METHODS: Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration.RESULTS: Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7 % and a specificity of 100%.CONCLUSIONS: rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.