Diagnosing growth in low-grade gliomas with and without longitudinal volume measurements: A retrospective observational study
Diagnosing growth in low-grade gliomas with and without longitudinal volume measurements: A retrospective observational study
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DOI：
10.1371/journal.pmed.1002810
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发表时间：
2019-05-01
期刊：
影响因子：
15.8
通讯作者：
Nabors, Louis B.
中科院分区：
文献类型：
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作者：
Fathallah-Shaykh, Hassan M.;DeAtkine, Andrew;Nabors, Louis B.
背景低级别胶质瘤因侵犯脑组织而导致严重的神经系统疾病。在临床环境中，没有普遍接受的客观技术可用于检测低级别胶质瘤的扩大;临床医生使用纵向放射学研究的视觉比较进行主观评价是金标准。本研究的目的是确定计算机辅助诊断（CAD）方法是否有助于医生早期发现低级别胶质瘤的生长。方法和结果我们回顾了2017年7月1日至2018年5月14日在伯明翰亚拉巴马大学诊所诊断为2级胶质瘤的165例患者。MRI扫描是在2018年春季和夏季收集的。五十六例胶质瘤符合入选标准，包括19例少突胶质细胞瘤、26例星形细胞瘤和11例混合型胶质瘤，男性30例，女性26例，平均年龄为48岁，随访时间范围为150.2个月（最高值和最低值之间的差异）。没有人接受放射治疗。我们还研究了7例无病理诊断的影像学异常患者，这些患者在回顾性审查时（2018年5月14日）临床稳定。本研究比较了7名医生通过CAD方法辅助的生长检测与回顾性临床报告。对627例MRI扫描中的63例患者（56 + 7）的肿瘤进行了数字化，包括34例放射学进展的2级胶质瘤和22例放射学稳定的2级胶质瘤。CAD方法包括肿瘤分割，计算体积，并通过在线突变点方法指向生长，该方法仅考虑过去的测量结果。独立的科学家已经评估了分割方法。在34例进展患者中的29例中，CAD的中位生长检测时间仅为14个月，而当前标准治疗放射学评估的中位生长检测时间为44个月（p < 0.001）。使用CAD，肿瘤增大的准确检测是可能的，肿瘤体积变化的中值仅为57%，相比之下，使用标准护理临床方法诊断肿瘤生长所需的体积变化的中值为174%（p < 0.001）。在放射学稳定组中，CAD促进了22例患者中13例的生长检测。CAD在成像异常组中未检测到生长。本研究的主要局限性在于其回顾性设计;然而，结果描述了临床实践中允许肿瘤体积从检测前基线显著增加的金标准的当前状态。在前瞻性设计中不允许肿瘤体积如此大的增加。胶质瘤患者的数量（n = 56）是一个限制，但是，它相当于在II期临床试验中的患者数量。结论纵向MRI扫描的视觉比较的当前实践与低级别胶质瘤的生长检测显着延迟。我们的研究结果支持这一观点，即CAD辅助下的医生检测到的生长量明显小于单独使用视觉比较的医生。这项研究没有回答是否治疗以及哪种治疗方式是最佳的问题。尽管如此，早期生长检测为解决这些问题以及早期治疗干预是否延长生存期和改善生活质量的未来临床研究奠定了基础。
Background Low-grade gliomas cause significant neurological morbidity by brain invasion. There is no universally accepted objective technique available for detection of enlargement of low-grade gliomas in the clinical setting; subjective evaluation by clinicians using visual comparison of longitudinal radiological studies is the gold standard. The aim of this study is to determine whether a computer-assisted diagnosis (CAD) method helps physicians detect earlier growth of low-grade gliomas.Methods and findings We reviewed 165 patients diagnosed with grade 2 gliomas, seen at the University of Alabama at Birmingham clinics from 1 July 2017 to 14 May 2018. MRI scans were collected during the spring and summer of 2018. Fifty-six gliomas met the inclusion criteria, including 19 oligodendrogliomas, 26 astrocytomas, and 11 mixed gliomas in 30 males and 26 females with a mean age of 48 years and a range of follow-up of 150.2 months (difference between highest and lowest values). None received radiation therapy. We also studied 7 patients with an imaging abnormality without pathological diagnosis, who were clinically stable at the time of retrospective review (14 May 2018). This study compared growth detection by 7 physicians aided by the CAD method with retrospective clinical reports. The tumors of 63 patients (56 + 7) in 627 MRI scans were digitized, including 34 grade 2 gliomas with radiological progression and 22 radiologically stable grade 2 gliomas. The CAD method consisted of tumor segmentation, computing volumes, and pointing to growth by the online abrupt change-of-point method, which considers only past measurements. Independent scientists have evaluated the segmentation method. In 29 of the 34 patients with progression, the median time to growth detection was only 14 months for CAD compared to 44 months for current standard of care radiological evaluation (p < 0.001). Using CAD, accurate detection of tumor enlargement was possible with a median of only 57% change in the tumor volume as compared to a median of 174% change of volume necessary to diagnose tumor growth using standard of care clinical methods (p < 0.001). In the radiologically stable group, CAD facilitated growth detection in 13 out of 22 patients. CAD did not detect growth in the imaging abnormality group. The main limitation of this study was its retrospective design; nevertheless, the results depict the current state of a gold standard in clinical practice that allowed a significant increase in tumor volumes from baseline before detection. Such large increases in tumor volume would not be permitted in a prospective design. The number of glioma patients (n = 56) is a limitation; however, it is equivalent to the number of patients in phase II clinical trials.Conclusions The current practice of visual comparison of longitudinal MRI scans is associated with significant delays in detecting growth of low-grade gliomas. Our findings support the idea that physicians aided by CAD detect growth at significantly smaller volumes than physicians using visual comparison alone. This study does not answer the questions whether to treat or not and which treatment modality is optimal. Nonetheless, early growth detection sets the stage for future clinical studies that address these questions and whether early therapeutic interventions prolong survival and improve quality of life.