A multimodal imaging-based classification for pediatric diffuse intrinsic pontine gliomas
A multimodal imaging-based classification for pediatric diffuse intrinsic pontine gliomas
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DOI：
10.1007/s10143-023-02068-3
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发表时间：
2023-06-26
影响因子：
2.8
通讯作者：
Zhang，Liwei
中科院分区：
文献类型：
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作者：
Pan，Changcun;Zhang，Mingxin;Zhang，Liwei
目的小儿弥漫性脑内桥胶质瘤（DIPG）是一种影像学异质性疾病实体，在此我们旨在建立一个基于影像学的多模态影像学分类，并在此分类框架下评估不同治疗策略的结果。方法这项回顾性研究包括2015年1月至2018年8月在北京天坛医院（中国北京）诊断为DIPG的103名儿童。多模态放射学特征，包括常规磁共振成像（MRI），弥散张量成像/弥散张量纤维束成像（DTI/DTT）和正电子发射断层扫描（PET）进行了审查，以构建分类。不同的治疗策略的结果进行了比较，在每个DIPG亚组使用Kaplan-Meier方法（对数秩检验），以确定最佳治疗特定DIPGsResultsFour放射DIPG类型被确定为：A型（“同心”，n=13），类型B（“腹侧”，n=41），C型（“偏心”，n=37），和D型（“背侧”，n=12）。治疗方式分为观察（43.7%）、肿瘤细胞减灭术（CRS）加放疗（RT）（24.3%）、单纯放疗（11.7%）和单纯CRS（20.4%）。CRS+RT以C型为主（29.7%），其次为B1型（21.9%）和D型（50%）。总体而言，CRS+RT表现出潜在的生存优势相比，单纯RT，这是更明显的特定类型，但这并没有达到统计学意义，由于有限的样本量和不平衡的distribution.ConclusionWe提出了一个多模态成像为基础的放射学分类儿科DIPG，这是有用的选择最佳的治疗策略，特别是用于识别可能受益于CRS加RT的候选人。该分类为儿科DIPG的图像引导综合治疗打开了一扇窗。
ObjectPediatric diffuse intrinsic pontine glioma (DIPG) is a radiologically heterogeneous disease entity, here we aim to establish a multimodal imaging-based radiological classification and evaluate the outcome of different treatment strategies under this classification frame.MethodsThis retrospective study included 103 children diagnosed with DIPGs between January 2015 and August 2018 in Beijing Tiantan Hospital (Beijing, China). Multimodal radiological characteristics, including conventional magnetic resonance imaging (MRI), diffuse tensor imaging/diffuse tensor tractography (DTI/DTT), and positron emission tomography (PET) were reviewed to construct the classification. The outcome of different treatment strategies was compared in each DIPG subgroup using Kaplan–Meier method (log-rank test) to determine the optimal treatment for specific DIPGs.ResultsFour radiological DIPG types were identified: Type A (“homocentric”,n=13), Type B (“ventral”,n=41), Type C (“eccentric”,n=37), and Type D (“dorsal”,n=12). Their treatment modalities were grouped as observation (43.7%), cytoreductive surgery (CRS) plus radiotherapy (RT) (24.3%), RT alone (11.7%), and CRS alone (20.4%). CRS+RT mainly fell into type C (29.7%), followed by type B1 (21.9%) and type D (50%). Overall, CRS+RT exhibited a potential survival advantage compared to RT alone, which was more pronounced in specific type, but this did not reach statistical significance, due to limited sample size and unbalanced distribution.ConclusionWe proposed a multimodality imaging-based radiological classification for pediatric DIPG, which was useful for selecting optimal treatment strategies, especially for identifying candidates who may benefit from CRS plus RT. This classification opened a window into image-guided integrated treatment for pediatric DIPG.