Differentiation between Solitary Cerebral Metastasis and Astrocytoma on the Basis of Subventricular Zone Involvement on Magnetic Resonance Imaging.
Differentiation between Solitary Cerebral Metastasis and Astrocytoma on the Basis of Subventricular Zone Involvement on Magnetic Resonance Imaging.
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基于磁共振成像脑室下区受累区分孤立性脑转移瘤和星形细胞瘤
DOI：
10.1371/journal.pone.0133480
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Yang J
中科院分区：
文献类型：
--
作者：
Wang R;Ma J;Niu G;Zheng J;Liu Z;Du Y;Yu B;Yang J
目的探讨脑室内下区（subventricular zone，SVZ）与星形细胞瘤的关系，以及SVZ受累是否可作为孤立性脑转移瘤（solitary cerebral metastasis，SCM）与星形细胞瘤的鉴别诊断指标。方法回顾性分析154例孤立性低级别星形细胞瘤（LGA）、高级别星形细胞瘤（HGA）及SCM患者的MRI表现，均行T1 WI、Gd-DTPA增强T1 WI、T2 WI或液体衰减反转恢复（FLAIR）T2 WI。增强T1 WI显示肿瘤与SVZ的空间关系为“累及”或“分隔”，非增强T2 WI/FLAIR T2 WI显示肿瘤与SVZ的空间关系为“累及”或“分隔”。比较LGA、HGA和SCM组之间基于患者的SVZ接触率。比较星形细胞瘤累及侧脑室不同区域的发生率。分析SVZ受累与肿瘤坏死的相关性。结果SCM、LGA和HGA的SVZ接触率分别为24.1%、68.8%和85.4%。单因素分析显示，SCM与星形细胞瘤之间SVZ接触率（24.1% vs.75.2%，P < 0.001），LGA与HGA之间SVZ接触率（68.1% vs.85.4%，P=0.037）存在显著差异。将肿瘤体积作为协变量调整后，SCM和星形细胞瘤之间的SVZ接触率仍然存在差异（比值比[OR]：4.58，95%置信区间[CI]：1.65至12.8，P=0.004）。LGA和HGA的肿瘤体积不同（P< 0.001），并影响SVZ受累与星形细胞瘤分级之间的关系（P = 0.05）。在侧脑室区域中，前角是最常见的星形细胞瘤。脑星形细胞瘤中坏死组SVZ接触率明显高于非坏死组（83.9%比50.0%，P < 0.001）。星形细胞瘤的坏死与SVZ受累呈正相关（rs = 0.342，P < 0.001），而SCMs的坏死与SVZ受累无关（P = 0.193）。结论与SCMs相比，孤立性脑星形细胞瘤与SVZ的空间位置接近，这可能有助于区分幕上星形细胞瘤和SCMs。
Purpose To determine the relationship between the subventricular zone (SVZ) and astrocytoma based on magnetic resonance imaging (MRI) and whether SVZ involvement can be used to distinguish solitary cerebral metastases (SCMs) from astrocytomas. Methods This retrospective study involved 154 patients with solitary low-grade astrocytoma (LGA), high-grade astrocytoma (HGA), and SCM, who underwent T1-weighted imaging (T1WI), Gd-DTPA–enhanced T1WI, and T2-weighted imaging (T2WI) or fluid-attenuated inversion recovery (FLAIR) T2WI. The spatial relationship between the tumor and SVZ was classified as “involvement” or “segregation” on contrast-enhanced T1WI for enhanced tumors and T2WI/FLAIR T2WI for non-enhanced tumors. Patient-based SVZ-contact rates were compared between the LGA, HGA, and SCM groups. The frequencies of involvement of various lateral ventricle regions by astrocytoma were compared. The correlation between SVZ involvement and tumor necrosis was analyzed. Results Patient-based SVZ-contact rates in SCM, LGA, and HGA were 24.1%, 68.8%, and 85.4%, respectively. Univariate analysis showed that the SVZ-contact rate was significantly different between SCM and astrocytoma (24.1% vs. 75.2% P < 0.001), also between LGA and HGA (68.1% vs. 85.4% P=0.037). After the tumor volume was adjusted as a covariate, SVZ-contact rates still differed between SCMs and astrocytomas (Odds ratio [OR]: 4.58, 95% Confidence interval [CI]: 1.65 to 12.8, P=0.004). Tumor volume differed between LGA and HGA (P< 0.001), and influenced the association between SVZ involvement and astrocytoma grade (P = 0.05). Among the lateral ventricle regions, the frontal horn was the most frequently involved by astrocytomas. SVZ-contact rates were higher in necrosis group compared with non-necrosis groups (83.9% vs. 50.0%, P < 0.001) among astrocytoma patients. Necrosis positively correlated with SVZ involvement in astrocytomas (rs = 0.342, P < 0.001), but did not correlate with SVZ involvement in SCMs (P = 0.193). Conclusions Compared to SCMs, solitary cerebral astrocytomas exhibited spatial proximity to the SVZ, which might distinguish the supratentorial astrocytomas from SCMs.