Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
Perfusion MRI-Based Fractional Tumor Burden Differentiates between Tumor and Treatment Effect in Recurrent Glioblastomas and Informs Clinical Decision-Making
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DOI：
10.3174/ajnr.a6211
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发表时间：
2019-10-01
影响因子：
3.5
通讯作者：
Fischbein, N.
中科院分区：
文献类型：
--
作者：
Iv, M.;Liu, X.;Fischbein, N.
背景和目的：在治疗的胶质母细胞瘤中，肿瘤负荷分数与组织学肿瘤体积分数的相关性优于其他灌注指标，如相对CBV。我们定义分数肿瘤负荷类低和高血容量区分肿瘤治疗效果，并确定是否分数肿瘤负荷可以告知治疗相关decision-making.MATERIALS和METHODS：47例高级别胶质瘤（主要是胶质母细胞瘤）与复发性对比增强病变的DSC-MR成像进行了回顾性评价手术后采样。组织学检查定义了治疗效果与肿瘤。使用1.0和1.75的标准化相对CBV阈值来定义每个组织病理学定义组中的低、中和高分数肿瘤负荷类别。用受试者工作特征曲线下面积评估性能。医生评估者之间的共识一致性报告了基于部分肿瘤负荷的治疗相关决策的假设变化，并与实际的实时治疗决策进行了比较。平均较低肿瘤负荷分数、高肿瘤负荷分数和对比增强体积的相对CBV在治疗效果和肿瘤之间存在显著差异。（P = .002，P < .001和P < .001），肿瘤具有显著较高的肿瘤负荷分数和相对CBV，而肿瘤负荷分数较低。中等肿瘤负荷分数无显著性差异。受试者工作特征曲线下面积的表现如下：高肿瘤负荷分数，0.85;低肿瘤负荷分数，0.7;相对CBV，0.81。在比较治疗决定，有分歧的7%的肿瘤和44%的治疗效果的情况下，在后者，所有的分歧是在分散的非典型celles.CONCLUSIONS：高分数肿瘤负荷和低分数肿瘤负荷定义分数的对比增强病变体积与高，低血容量，分别，并可以区分肿瘤复发胶质母细胞瘤的治疗效果。部分肿瘤负荷图也可以帮助告知临床决策。
BACKGROUND AND PURPOSE: Fractional tumor burden better correlates with histologic tumor volume fraction in treated glioblastoma than other perfusion metrics such as relative CBV. We defined fractional tumor burden classes with low and high blood volume to distinguish tumor from treatment effect and to determine whether fractional tumor burden can inform treatment-related decision-making.MATERIALS AND METHODS: Forty-seven patients with high-grade gliomas (primarily glioblastoma) with recurrent contrast-enhancing lesions on DSC-MR imaging were retrospectively evaluated after surgical sampling. Histopathologic examination defined treatment effect versus tumor. Normalized relative CBV thresholds of 1.0 and 1.75 were used to define low, intermediate, and high fractional tumor burden classes in each histopathologically defined group. Performance was assessed with an area under the receiver operating characteristic curve. Consensus agreement among physician raters reporting hypothetic changes in treatment-related decisions based on fractional tumor burden was compared with actual real-time treatment decisions.RESULTS: Mean lower fractional tumor burden, high fractional tumor burden, and relative CBV of the contrast-enhancing volume were significantly different between treatment effect and tumor (P = .002, P < .001, and P < .001), with tumor having significantly higher fractional tumor burden and relative CBV and lower fractional tumor burden. No significance was found with intermediate fractional tumor burden. Performance of the area under the receiver operating characteristic curve was the following: high fractional tumor burden, 0.85; low fractional tumor burden, 0.7; and relative CBV, 0.81. In comparing treatment decisions, there were disagreements in 7% of tumor and 44% of treatment effect cases; in the latter, all disagreements were in cases with scattered atypical cells.CONCLUSIONS: High fractional tumor burden and low fractional tumor burden define fractions of the contrast-enhancing lesion volume with high and low blood volume, respectively, and can differentiate treatment effect from tumor in recurrent glioblastomas. Fractional tumor burden maps can also help to inform clinical decision-making.