Prediction of survival and progression in glioblastoma patients using temporal perfusion changes during radiochemotherapy
Prediction of survival and progression in glioblastoma patients using temporal perfusion changes during radiochemotherapy
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DOI：
10.1016/j.mri.2020.01.012
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发表时间：
2020-05-01
影响因子：
2.5
通讯作者：
Bjornerud, Atle
中科院分区：
文献类型：
--
作者：
Larsson, Christopher;Groote, Inge;Bjornerud, Atle
背景资料：本研究的目的是根据RANO标准研究结构磁共振成像（MRI）的变化，以及来自动态对比增强MRI（DCE）和动态磁敏感对比MRI（DSC）的灌注和渗透性相关指标，用于预测胶质母细胞瘤的进展和生存。23例胶质母细胞瘤患者在6周的放化疗前、放化疗中和放化疗后2周接受了每两周一次的结构和灌注MRI检查。肿瘤体积的时间趋势和灌注衍生参数脑血容量（CBV）和血流量（CBF）从DSC和DCE，除了造影剂毛细管传输常数（K-transs）从DCE，进行了评估。根据中位生存期将患者分为两组，并探讨两组之间的差异。临床和MRI指标进行了调查，使用单变量和多变量生存分析和预测生存指数生成。在放疗期间和放疗后两周，对比增强肿瘤大小以及DCE和DSC衍生参数中的CBV和CBF均显著降低（p < 0.05）。放疗结束后两周K-transs/CBF增加10%/30%导致生存期显著缩短（13.9/16.8 vs. 31.5/33.1个月; p < 0.05）。多变量分析显示，使用DSC的K-transs和相对CBV变化的指数与生存时间（月）显著对应（r（2）= 0.843; p < 0.001）。结论：在胶质母细胞瘤患者中，肿瘤大小（两周后）和灌注加权MRI衍生参数（四周后）在放化疗期间有明显的时间变化。虽然基于DCE的指标显示出早期生存预测的最有希望，但DCE和DSC衍生指标的多参数组合提供了额外的信息。
Background: The aim of this study was to investigate changes in structural magnetic resonance imaging (MRI) according to the RANO criteria and perfusion- and permeability related metrics derived from dynamic contrast-enhanced MRI (DCE) and dynamic susceptibility contrast MRI (DSC) during radiochemotherapy for prediction of progression and survival in glioblastoma.Methods: Twenty-three glioblastoma patients underwent biweekly structural and perfusion MRI before, during, and two weeks after a six weeks course of radiochemotherapy. Temporal trends of tumor volume and the perfusion-derived parameters cerebral blood volume (CBV) and blood flow (CBF) from DSC and DCE, in addition to contrast agent capillary transfer constant (K-trans) from DCE, were assessed. The patients were separated in two groups by median survival and differences between the two groups explored. Clinical- and MRI metrics were investigated using univariate and multivariate survival analysis and a predictive survival index was generated.Results: Median survival was 19.2 months. A significant decrease in contrast-enhancing tumor size and CBV and CBF in both DCE- and DSC-derived parameters was seen during and two weeks past radiochemotherapy (p < 0.05). A 10%/30% increase in K-trans/CBF two weeks after finishing radiochemotherapy resulted in significant shorter survival (13.9/16.8 vs. 31.5/33.1 months; p < 0.05). Multivariate analysis revealed an index using change in K-trans and relative CBV from DSC significantly corresponding with survival time in months (r(2) = 0.843; p < 0.001).Conclusions: Significant temporal changes are evident during radiochemotherapy in tumor size (after two weeks) and perfusion-weighted MRI-derived parameters (after four weeks) in glioblastoma patients. While DCE-based metrics showed most promise for early survival prediction, a multiparametric combination of both DCE-and DSC-derived metrics gave additional information.