Relationship of pre-surgery metabolic and physiological MR imaging parameters to survival for patients with untreated GBM
Relationship of pre-surgery metabolic and physiological MR imaging parameters to survival for patients with untreated GBM
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DOI：
10.1007/s11060-008-9719-x
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发表时间：
2009-02-01
影响因子：
3.9
通讯作者：
Nelson, Sarah J.
中科院分区：
文献类型：
--
作者：
Crawford, Forrest W.;Khayal, Inas S.;Nelson, Sarah J.
多形性胶质母细胞瘤（GBM）无论是在解剖图像上的外观还是对治疗的反应方面都是异质性病变。本研究的目的是评估源自这些病变的生理和代谢图像的参数的预后价值。 56 名 GBM 患者在手术切除前立即使用传统解剖 MR 成像进行扫描，并在可能的情况下使用灌注加权成像、扩散加权成像和质子 MR 光谱成像。中位生存时间为 517 天，其中 15 名患者接受了审查。绝对解剖病变体积与生存率无关，但对比增强和坏死的组合体积占 T2 高信号病变比例较大的患者的生存率相对较差。与生存较差相关的其他体积参数是胆碱与 N-乙酰天冬氨酸指数 (CNI) 升高的区域的体积以及表观扩散系数 (ADC) 小于白质 1.5 倍的 T2 病变内的体积。与生存相关的强度参数是 CNI 病变内乳酸和脂质水平的最大值和总和，以及对比增强病变内标准化 ADC 第 10 个百分位数的大小。影像学参数显示血脑屏障破坏或坏死比例较大、大面积代谢异常或扩散受限区域的患者生存率较低。这些参数可以为预测结果以及将患者分层为临床试验的高风险组或低风险组提供有用的信息。
Glioblastoma Multiforme (GBM) are heterogeneous lesions, both in terms of their appearance on anatomic images and their response to therapy. The goal of this study was to evaluate the prognostic value of parameters derived from physiological and metabolic images of these lesions. Fifty-six patients with GBM were scanned immediately before surgical resection using conventional anatomical MR imaging and, where possible, perfusion-weighted imaging, diffusion-weighted imaging, and proton MR spectroscopic imaging. The median survival time was 517 days, with 15 patients censored. Absolute anatomic lesion volumes were not associated with survival but patients for whom the combined volume of contrast enhancement and necrosis was a large percentage of the T2 hyperintense lesion had relatively poor survival. Other volumetric parameters linked with less favorable survival were the volume of the region with elevated choline to N-acetylaspartate index (CNI) and the volume within the T2 lesion that had apparent diffusion coefficient (ADC) less than 1.5 times that in white matter. Intensity parameters associated with survival were the maximum and the sum of levels of lactate and of lipid within the CNI lesion, as well as the magnitude of the 10th percentile of the normalized ADC within the contrast-enhancing lesion. Patients whose imaging parameters indicating that lesions with a relatively large percentage with breakdown of the blood brain barrier or necrosis, large regions with abnormal metabolism or areas with restricted diffusion have relatively poor survival. These parameters may provide useful information for predicting outcome and for the stratification of patients into high or low risk groups for clinical trials.