Prospective analysis of parametric response map-derived MRI biomarkers: identification of early and distinct glioma response patterns not predicted by standard radiographic assessment.
Prospective analysis of parametric response map-derived MRI biomarkers: identification of early and distinct glioma response patterns not predicted by standard radiographic assessment.
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DOI：
10.1158/1078-0432.ccr-10-2098
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发表时间：
2011-07-15
期刊：
影响因子：
--
通讯作者：
Ross BD
中科院分区：
文献类型：
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作者：
Galbán CJ;Chenevert TL;Meyer CR;Tsien C;Lawrence TS;Hamstra DA;Junck L;Sundgren PC;Johnson TD;Galbán S;Sebolt-Leopold JS;Rehemtulla A;Ross BD
目前，脑肿瘤的放射学反应是在治疗开始10周后根据麦克唐纳标准进行评估的。迫切需要在治疗过程中及早确定无反应患者，以考虑替代治疗策略。我们的研究评估了参数反应图(PRM)成像生物标记物的有效性，以提供患者生存预测的早期测量。45例高级别胶质瘤患者同时接受放化疗。在治疗前和治疗中3周获得包括表观弥散系数(ADC)和相对脑血容量(RCBV)图在内的定量MRI，这是一项经机构批准的前瞻性研究。PRM是一种逐个体素的图像分析方法，被评估为总体生存的早期预后生物标志物。并对临床和常规MR参数进行了评估。多变量分析显示，与任何基线临床或治疗反应成像指标相比，在第3周获得的PRMADC+和PRMR CBV-与一年和总体存活率的相关性更强。复合生物标记物确定了三个不同的患者组，无反应者(中位生存期5.5个月，CI：4.4-6.6个月)，部分应答者(MS 16个月，CI：8.6-23.4)和有反应者(MS尚未达到)。将PRMADC+和PRMRCBV-纳入单一成像生物标志物指标，可早期识别对标准化疗耐药的患者。与目前评估10周反应的标准(麦克唐纳标准)相比，复合PRM生物标记物潜在地为临床医生提供了一个有用的机会来识别可能从替代治疗策略中受益的患者。
Currently, radiologic response of brain tumors is assessed according to the Macdonald criteria 10 weeks from the start of therapy. There exists a critical need to identify non-responding patients early in the course of their therapy for consideration of alternative treatment strategies. Our study assessed the effectiveness of the Parametric Response Map (PRM) imaging biomarker to provide for an earlier measure of patient survival prediction. Forty-five high grade glioma patients received concurrent chemoradiation. Quantitative MRI including apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) maps were acquired pre-treatment and 3 weeks mid-treatment on a prospective institutional-approved study. PRM, a voxel-by-voxel image analysis method, was evaluated as an early prognostic biomarker of overall survival. Clinical and conventional MR parameters were also evaluated. Multivariate analysis showed that PRMADC+ in combination with PRMrCBV- obtained at week 3 had a stronger correlation to one-year and overall survival rates than any baseline clinical or treatment response imaging metric. The composite biomarker identified three distinct patient groups, non-responders (median survival (MS) of 5.5 months CI: 4.4-6.6) months, partial responders (MS of 16 months CI: 8.6-23.4) and responders (MS has not yet been reached.) Inclusion of PRMADC+ and PRMrCBV- into a single imaging biomarker metric provided early identification of patients resistant to standard chemoradiation. In comparison to the current standard of assessment of response at 10 weeks (MacDonald Criteria) the composite PRM biomarker potentially provides a useful opportunity for clinicians to identify patients who may benefit from alternative treatment strategies.