Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging
Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging
复制标题
DOI：
10.1177/0284185112474916
复制
发表时间：
2013-05-01
期刊：
影响因子：
1.3
通讯作者：
Suh, Dae Chul
中科院分区：
文献类型：
--
作者：
Choi, Young Jun;Kim, Ho Sung;Suh, Dae Chul
背景：假性进展是一种治疗相关反应，表现为造影剂增强的病灶增大，随后改善。区分肿瘤复发和假性进展仍然是神经肿瘤学中的一个问题。目的：与单独的动态磁敏感对比（DSC）灌注磁共振成像（MRI）相比，验证动脉自旋标记（ASL）在区分新诊断的多形性胶质母细胞瘤（GBM）患者的早期肿瘤进展和假性进展中的附加价值。材料和方法：我们回顾性评估了117例新诊断GBM的连续患者，这些患者接受了手术切除和同步放化疗（CCRT）作为标准治疗方式。通过ASL和DSC灌注MRI评估了62例发生对比增强病变的患者，并根据病理分析或临床放射学随访将其分为早期肿瘤复发组（n = 34）或假性进展组（n = 28）。我们使用定性分析和半定量分级系统，根据ASL成像上的肿瘤灌注信号强度分为白色物质（I级）、灰质（II级）和血管（III级）。ASL分级与DSC灌注MRI的直方图参数相关。在15例患者中观察到假性进展（53.6%）ASL I级患者，13（46.4%）为II级，0（0%）为III级，7例患者观察到早期肿瘤进展。ASL I级患者占20.6%，II级患者占11例（32.3%），III级患者占16例（47.1%）（P = 0.0022）。DSC灌注直方图参数在ASL等级之间差异显著。ASL分级是区分假进展与早期肿瘤进展的独立预测因子（比值比，4.73; P = 0.0017）。在定性回顾中，连续ASL产生了8个（12.9%）更准确的结果比DSC灌注MRIsingle.Conclusion：ASL提高了诊断准确性DSC灌注MRI在区分假进展，早期肿瘤进展。
Background: Pseudoprogression is a treatment-related reaction with an increase in contrast-enhancing lesion size, followed by subsequent improvement. Differentiating tumor recurrence from pseudoprogression remains a problem in neuro-oncology.Purpose: To validate the added value of arterial spin labeling (ASL), compared with dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) alone, in distinguishing early tumor progression from pseudoprogression in patients with newly diagnosed glioblastoma multiforme (GBM).Material and Methods: We retrospectively evaluated 117 consecutive patients with newly diagnosed GBM who underwent surgical resection and concurrent chemoradiotherapy (CCRT) as standard treatment modality. Sixty-two patients who developed contrast-enhancing lesions were assessed by both ASL and DSC perfusion MRI and classified into groups of early tumor recurrence (n = 34) or pseudoprogression (n = 28) based on pathologic analysis or clinical-radiologic follow-up. We used a qualitative analysis and semi-quantitative grade system on the basis of the tumor perfusion signal intensity into those equal to white matter (grade I), gray matter (grade II), and blood vessels (grade III) on ASL imaging. ASL grade was correlated with histogram parameters derived from DSC perfusion MRI.Results: Pseudoprogression was observed in 15 (53.6%) patients with ASL grade I, 13 (46.4%) with grade II, and 0 (0%) with grade III, with early tumor progression observed in seven (20.6%) patients with ASL grade I, 11 (32.3%) with grade II, and 16 (47.1%) with grade III (P = 0.0022). DSC perfusion histogram parameters differed significantly among ASL grades. ASL grade was an independent predictor differentiating pseudoprogression from early tumor progression (odds ratio, 4.73; P = 0.0017). On qualitative review, adjunctive ASL produced eight (12.9%) more accurate results than DSC perfusion MRI alone.Conclusion: ASL improves the diagnostic accuracy of DSC perfusion MRI in differentiating pseudoprogression from early tumor progression.