Identifying Recurrent Malignant Glioma after Treatment Using Amide Proton Transfer-Weighted MR Imaging: A Validation Study with Image-Guided Stereotactic Biopsy.
Identifying Recurrent Malignant Glioma after Treatment Using Amide Proton Transfer-Weighted MR Imaging: A Validation Study with Image-Guided Stereotactic Biopsy.
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DOI：
10.1158/1078-0432.ccr-18-1233
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发表时间：
2019-01-15
期刊：
影响因子：
--
通讯作者：
Zhou J
中科院分区：
文献类型：
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作者：
Jiang S;Eberhart CG;Lim M;Heo HY;Zhang Y;Blair L;Wen Z;Holdhoff M;Lin D;Huang P;Qin H;Quinones-Hinojosa A;Weingart JD;Barker PB;Pomper MG;Laterra J;van Zijl PCM;Blakeley JO;Zhou J
通过放射引导立体定向组织验证，量化酰胺质子转移加权（APTw） MRI在治疗后识别活动性胶质瘤的准确性。21例因肿瘤进展与治疗效果相关的MRI特征而接受手术的患者术前进行了APTw成像。在不同APTw信号强度的感兴趣区域进行立体定向活检。相对于APTw结果，分析64例标本的最终临床病理和组织病理学之间的关系。分析确诊复发肿瘤或治疗效果组织进行受试者工作特征（ROC）分析。21例患者中肿瘤复发18例，临床病理治疗效果3例。在12例患者中，在同一肿瘤内确认了多个组织病理分配。在64个标本中，20个标本为活动性胶质瘤，27个标本为活动性和静止性胶质瘤混合，17个标本为静止或未识别的肿瘤。APTw信号强度与组织病理分配、细胞结构、增殖指数呈显著正相关（R分别为0.651、0.580、0.458，P均< 0.001）。ROC分析显示，APTw强度临界值为1.79%，区分活动性和非活动性肿瘤（AUC为0.881），敏感性为85.1%，特异性为94.1%。临床病理分析显示，每位患者的平均APTw强度在该截止点识别复发性胶质瘤的敏感性为94.4%，阳性预测值为100%。APTw成像高强度可能是恶性胶质瘤活动性的标志。它能够在解剖性脑MRI上区分异质异常区域，具有很高的敏感性和特异性。
To quantify the accuracy of amide proton transfer-weighted (APTw) MRI for identifying active glioma post-treatment via radiographically guided stereotactic tissue validation. Twenty-one patients referred for surgery for MRI features concerning for tumor progression versus treatment effect underwent pre-operative APTw imaging. Stereotactic biopsies were taken from regions of interest with varying APTw signal intensities. The relationship between final clinical pathology as well as the histopathology of each of the 64 specimens was analyzed relative to APTw results. Analysis of confirmed recurrent tumor or treatment effect tissue was used to perform receiver-operating-characteristic (ROC) analysis. Eighteen of 21 patients had recurrent tumor, and 3 had treatment effect on clinical pathology. In 12 patients, there were multiple histopathologic assignments confirmed within the same tumor. Of the 64 total specimens, 20 specimens were active glioma, 27 mixed active and quiescent glioma, and 17 quiescent/no identifiable tumor. APTw signal intensity and histopathologic assignment, cellularity, and proliferation index had significant positive correlations (R = 0.651, 0.580, and 0.458, respectively; all P < 0.001). ROC analysis with a 1.79% APTw intensity cutoff differentiated active from non-active tumor (AUC of 0.881) with 85.1% sensitivity and 94.1% specificity. Analysis of clinical pathology showed the mean APTw intensity for each patient had 94.4% sensitivity and 100% positive predictive value for identifying recurrent glioma at this cutoff. APTw imaging hyperintensity may be a marker of active malignant glioma. It is able to distinguish between regions of heterogeneous abnormality on anatomical brain MRI with high sensitivity and specificity.