Comparison of Three Different MR Perfusion Techniques and MR Spectroscopy for Multiparametric Assessment in Distinguishing Recurrent High-Grade Gliomas from Stable Disease
Comparison of Three Different MR Perfusion Techniques and MR Spectroscopy for Multiparametric Assessment in Distinguishing Recurrent High-Grade Gliomas from Stable Disease
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DOI：
10.1016/j.acra.2013.09.003
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发表时间：
2013-12-01
影响因子：
4.8
通讯作者：
Bisdas, Sotirios
中科院分区：
文献类型：
--
作者：
Seeger, Achim;Braun, Christian;Bisdas, Sotirios
基本原理和目标：磁共振（MR）灌注技术和磁共振波谱（MRS）提供了特异性的生理信息，可以区分复发性胶质瘤和稳定性胶质瘤的进展。40例患者接受了常规MR成像、动态增强T1加权灌注成像、动态磁化率增强灌注成像（DSC），其中26例患者的动脉自旋标记可用。在肿瘤复发和疾病稳定时计算定量参数，并在临床和放射学随访中进行回顾性验证。生成每个参数的受试者工作特征曲线以区分复发性胶质瘤和稳定性疾病。一个向前的判别分析进行评估的权力相结合的MR灌注技术和MRS。结果：40例患者中，23例被确定为复发性胶质瘤。两组之间的动脉自旋标记差异无统计学意义（P = 0.063）。动态增强T1加权灌注成像和DSC检测复发病灶的敏感性和特异性分别为61.9%和80%的转移常数k（transs），77.3%和84.6%的脑血流量，81%和76.9%的脑血容量，分别。在MRS的参数中，胆碱与标准化肌酸的比值显示出最好的诊断准确性（P = 0.014;敏感性70%，特异性78.6%）。结论：MR灌注技术和MRS是鉴别复发胶质瘤和稳定胶质瘤的有效工具。在单参数中，DSC表现出最好的诊断性能。多参数评估大大提高了区分这两个实体的能力。
Rationale and Objectives: Magnetic resonance (MR) perfusion techniques and MR spectroscopy (MRS) provide specific physiological information that may allow distinction between recurrent glioma and progression from stable disease.Materials and Methods: Forty patients underwent conventional MR imaging, dynamic contrast-enhanced T1-weighted perfusion imaging, dynamic susceptibility contrast-enhanced perfusion imaging (DSC), and multivoxel MRS. Arterial spin labeling was available in 26 of these patients. Quantitative parameters were calculated in tumor recurrences and stable disease, which were retrospectively verified on clinical and radiological follow-up. Receiver operating characteristic curves for each parameter were generated for the differentiation between recurrent glioma and stable disease. A forward discriminant analysis was undertaken to assess the power of the conjunction of MR perfusion techniques and MRS.Results: Of the 40 patients, 23 were determined to have recurrent gliomas. Differences in arterial spin labeling between the two groups were not statistically significant (P = .063). Sensitivities and specificities for the detection of recurrent lesions in dynamic contrast-enhanced T1-weighted perfusion imaging and DSC were 61.9% and 80% transfer constant k(trans), 77.3% and 84.6% for cerebral blood flow, and 81% and 76.9% for cerebral blood volume, respectively. Among the parameters in MRS, the ratio of choline to normalized creatine showed the best diagnostic accuracy (P = .014; sensitivity 70%, specificity 78.6%). When considering all perfusion modalities, diagnostic accuracy could be increased to 82.5%, adding MRS to the multiparametric approach resulted in a diagnostic accuracy of 90.0%.Conclusions: MR perfusion techniques and MRS are useful tools that enable improved differentiation between recurrent glioma and stable disease. Among the single parameters, DSC showed the best diagnostic performance. Multiparametric assessment substantially improved the ability to differentiate the two entities.