Malignant astrocytic tumors: Clinical importance of apparent diffusion coefficient in prediction of grade and prognosis
Malignant astrocytic tumors: Clinical importance of apparent diffusion coefficient in prediction of grade and prognosis
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DOI：
10.1148/radiol.2413051276
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发表时间：
2006-12-01
期刊：
影响因子：
19.7
通讯作者：
Takahashi, Shoki
中科院分区：
文献类型：
--
作者：
Higano, Shuichi;Yun, Xia;Takahashi, Shoki
目的：回顾性评估表观扩散系数（ADC）预测恶性星形细胞肿瘤的恶性程度和预后。材料和方法：机构审查委员会批准了这项研究，并没有要求患者知情同意。回顾性评价了37例经病理证实的恶性星形细胞肿瘤患者（21例男性，16例女性;平均年龄43岁）的结果，其中包括22例胶质母细胞瘤（GBM）和15例间变性星形细胞瘤（AA）。每个肿瘤的最小ADC值术前确定从几个区域的利益定义的肿瘤，最好避免囊性或坏死成分，在ADC图来自各向同性扩散加权图像。根据医院方案，在所有病例中进行手术干预和放射治疗。免疫组织学，Ki-67标记指数（LI），表明细胞增殖，也进行了测定。根据首次治疗后2年的观察结果，将患者分为进展组和稳定组。相关分析（Pearson积差相关）、Student t检验、Welch检验、受试者工作特征分析和Kaplan-Meier方法结合logrank检验用于统计学评估。平均最小ADC（0.834 x 10（-1）mm（2）（.）s（-1））显著低于1.06 × 10（-3）mm（2）（.）sec（-1））（P < .001，Student t检验）。平均最小ADC（0.80 × 10（-3）mm（2）（.）s（-1））显著低于（1.037 x 10（-3）mm（2 .）s（-1））（P < .001）。0.90 x 10（-3）mm（2 .）sec（-1）的最小ADC值用于区分预后良好的患者和预后不良的患者，提供了灵敏度（79%）和特异性（81%）的最佳组合（受试者操作特征分析）。使用最小ADC临界值分类的两组之间的预后存在显着差异（P = .002，对数秩检验）。结论：恶性星形细胞瘤的最小ADC可以提供与治疗后预后相关的临床恶性程度的额外信息。
Purpose: To retrospectively assess the apparent diffusion coefficient (ADC) for prediction of malignancy and prognosis of malignant astrocytic tumors.Materials and Methods: The institutional review board approved this study and did not require patient informed consent. Findings from 37 consecutive patients (21 men, 16 women; mean age, 43 years) with pathologically proved malignant astrocytic tumors that included 22 glioblastomas (GBMs) and 15 anaplastic astrocytomas (AAs) were retrospectively evaluated. The minimum ADC value of each tumor was preoperatively determined from several regions of interest defined in the tumor, preferably with avoidance of cystic or necrotic components, on ADC maps derived from isotropic diffusion-weighted images. Surgical intervention followed by radiation therapy, was undertaken in all cases according to hospital protocol. Immunohistologically, Ki-67 labeling index (LI), indicating cell proliferation, was also determined. The patients were classified into two groups, progressive and stable, according to the 2-year observation after the initial treatment. Correlation analysis (Pearson product moment correlation), Student t test, Welch test, receiver operating characteristic analysis, and Kaplan-Meier method with log-rank test were used for statistical evaluation.Results: There was a significant, negative correlation between minimum ADC and Ki-67 Ll (r = -0.562, P < .001). The mean minimum ADC (0.834 x 10(-1) mm(2) (.) sec(-1)) of GBM was significantly lower than that (1.06 x 10(-3) mm(2) (.) sec(-1)) of AA (P < .001, Student t test). The mean minimum ADC (0.80 x 10(-3) mm(2) (.) sec(-1)) of the progressive group was significantly lower than that (1.037 x 10(-3) mm(2 .) sec(-1)) of the stable group (P < .001). The cutoff value of 0.90 x 10(-3) mm(2 .) sec(-1) for minimum ADC for differentiation of patients with a favorable prognosis from those with a poor prognosis provided the best combination of sensitivity (79%) and specificity (81%) (receiver operating characteristic analysis). The significant difference in the prognosis between two groups classified by using this cutoff value of minimum ADC was noted (P = .002, log-rank test).Conclustion: The minimum ADC of malignant astrocytomas can provide additional information about their clinical malignancy related to posttreatment prognosis.