Persistent Peri-Ablation Blood-Brain Barrier Opening After Laser Interstitial Thermal Therapy for Brain Tumors.
Persistent Peri-Ablation Blood-Brain Barrier Opening After Laser Interstitial Thermal Therapy for Brain Tumors.
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DOI：
10.7759/cureus.37397
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发表时间：
2023-04
期刊：
影响因子：
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通讯作者：
Lee IY
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文献类型：
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作者：
Bartlett S;Nagaraja TN;Griffith B;Farmer KG;Van Harn M;Haider S;Hunt RJ;Cabral G;Knight RA;Valadie OG;Brown SL;Ewing JR;Lee IY
目的激光间质热治疗（LITT）是一种微创、图像引导、细胞减少的治疗复发性胶质母细胞瘤的方法。本研究采用动态对比增强磁共振成像（DCE-MRI）方法，并采用模型选择范式对消融附近litt后血脑屏障（BBB）渗透率进行定位和量化。测定血清神经元特异性烯醇化酶（NSE）水平，这是血脑屏障通透性增加的外周标志物。方法选取17例患者。采用酶联免疫吸附测定法，术前、术后24小时、术后2周、8周、12周和16周（取决于术后辅助治疗）测定血清NSE。在17名患者中，4名患者有纵向DCE-MRI数据，从中评估血脑正向容量转移常数（Ktrans）数据。术前、术后24小时、术后2 - 8周进行影像学检查。结果血清NSE在消融后24小时升高（p=0.04），术后2周达到峰值，8周恢复至基线水平。手术后24小时，Ktrans在消融周围被发现升高。这种增长持续了两周。结论：LITT手术后，血清NSE水平和DCE-MRI估计的消融周Ktrans在消融后的前两周增加，提示血脑屏障通透性短暂增加。
Purpose Laser interstitial thermal therapy (LITT) is a minimally invasive, image-guided, cytoreductive procedure to treat recurrent glioblastoma. This study implemented dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) methods and employed a model selection paradigm to localize and quantify post-LITT blood-brain barrier (BBB) permeability in the ablation vicinity. Serum levels of neuron-specific enolase (NSE), a peripheral marker of increased BBB permeability, were measured. Methods Seventeen patients were enrolled in the study. Using an enzyme-linked immunosorbent assay, serum NSE was measured preoperatively, 24 hours postoperatively, and at two, eight, 12, and 16 weeks postoperatively, depending on postoperative adjuvant treatment. Of the 17 patients, four had longitudinal DCE-MRI data available, from which blood-to-brain forward volumetric transfer constant (Ktrans) data were assessed. Imaging was performed preoperatively, 24 hours postoperatively, and between two and eight weeks postoperatively. Results Serum NSE increased at 24 hours following ablation (p=0.04), peaked at two weeks, and returned to baseline by eight weeks postoperatively. Ktrans was found to be elevated in the peri-ablation periphery 24 hours after the procedure. This increase persisted for two weeks. Conclusion Following the LITT procedure, serum NSE levels and peri-ablation Ktrans estimated from DCE-MRI demonstrated increases during the first two weeks after ablation, suggesting transiently increased BBB permeability.