Integration of preoperative anatomic and metabolic physiologic imaging of newly diagnosed glioma.
Integration of preoperative anatomic and metabolic physiologic imaging of newly diagnosed glioma.
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DOI：
10.1007/s11060-009-9845-0
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发表时间：
2009-05
影响因子：
3.9
通讯作者：
Berger, Mitchel
中科院分区：
文献类型：
--
作者：
Chang, Susan M.;Nelson, Sarah;Vandenberg, Scott;Cha, Soonmee;Prados, Michael;Butowski, Nicholas;McDermott, Michael;Parsa, Andrew T.;Aghi, Manish;Clarke, Jennifer;Berger, Mitchel
将标准解剖磁共振成像与统一采集的不同组织学分级的未经治疗胶质瘤的生理成像生物标志物相结合，以生成可用于患者管理的算法。共有143例既往未经治疗的胶质瘤患者在手术切除前立即使用常规解剖MR成像进行扫描，并使用均匀采集的灌注加权成像，扩散加权成像和质子MR光谱成像。确定对应于解剖和代谢病变的感兴趣区域以评估肿瘤负荷。MR参数已被发现是预测生存的IV级胶质瘤患者进行了评估，作为一个功能的肿瘤分级和组织学亚型。基于这些发现，解剖学和生理学成像参数，然后整合，以生成一个算法，用于管理新诊断的假定胶质瘤患者。组织学分析表明，该人群包括56例II级，31例III级和56例IV级胶质瘤患者。基于标准的解剖成像，钆后T1加权图像中低信号坏死区域的存在和T2高信号病变的百分比，无论是增强或坏死是有效的识别IV级胶质瘤患者。与少突胶质细胞瘤亚型相比，II级星形细胞瘤患者的弥散和灌注参数的个体参数存在显著差异。所有肿瘤的胆碱/N-乙酰胆碱酯指数（CNI）均升高。III级和IV级胶质瘤的乳酸盐较高，IV级胶质瘤的脂质显著升高。这些结果被整合到新诊断的胶质瘤的拟议管理算法中，需要在未来的研究中进行前瞻性测试。代谢和生理成像特征提供了关于肿瘤异质性的信息，这对于帮助外科医生确保获得代表性组织学可能是重要的。需要评估这些综合MR参数与临床特征的相关性，以确定其在预测结局和将患者分为临床试验风险组方面的作用。未来的研究将使用图像引导的组织采样来确认这些参数的生物学解释，并评估它们如何响应治疗而变化。
To integrate standard anatomic magnetic resonance imaging in conjunction with uniformly acquired physiologic imaging biomarkers of untreated glioma with different histological grades with the goal of generating an algorithm that can be applied for patient management. A total of 143 patients with previously untreated glioma were scanned immediately before surgical resection using conventional anatomical MR imaging, and with uniform acquisition of perfusion-weighted imaging, diffusion-weighted imaging, and proton MR spectroscopic imaging. Regions of interest corresponding to anatomic and metabolic lesions were identified to assess tumor burden. MR parameters that had been found to be predictive of survival in patients with grade IV glioma were evaluated as a function of tumor grade and histological sub-type. Based on these finding both anatomic and physiologic imaging parameters were then integrated to generate an algorithm for management of patients with newly diagnosed presumed glioma. Histological analysis indicated that the population comprised 56 patients with grade II, 31 with grade III, and 56 with grade IV glioma. Based on standard anatomic imaging, the presence of hypointense necrotic regions in post-Gadolinium T1-weighted images and the percentage of the T2 hyperintense lesion that was either enhancing or necrotic were effective in identifying patients with grade IV glioma. The individual parameters of diffusion and perfusion parameters were significantly different for patients with grade II astrocytoma versus oligodendroglioma sub-types. All tumors had regions with elevated choline to N-acetylasparate index (CNI). Lactate was higher for grade III and grade IV glioma and lipid was significantly elevated for grade IV glioma. These results were integrated into a proposed management algorithm for newly diagnosed glioma that will need to be prospectively tested in future studies. Metabolic and physiologic imaging characteristics provide information about tumor heterogeneity that may be important for assisting the surgeon to ensure acquisition of representative histology. Correlation of these integrated MR parameters with clinical features will need to be assessed with respect to their role in predicting outcome and stratifying patients into risk groups for clinical trials. Future studies will use image directed tissue sampling to confirm the biological interpretation of these parameters and to assess how they change in response to therapy.
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