Multiparametric MR Imaging of Diffusion and Perfusion in Contrast-enhancing and Nonenhancing Components in Patients with Glioblastoma
Multiparametric MR Imaging of Diffusion and Perfusion in Contrast-enhancing and Nonenhancing Components in Patients with Glioblastoma
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DOI：
10.1148/radiol.2017160150
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发表时间：
2017-07-01
期刊：
影响因子：
19.7
通讯作者：
Price, Stephen J.
中科院分区：
文献类型：
--
作者：
Boonzaier, Natalie R.;Larkin, Timothy J.;Price, Stephen J.
目的：确定低表观扩散系数 (ADC) 和高相对脑血容量 (rCBV) 区域是否代表胆碱 (Cho) 与 N-乙酰天冬氨酸 (NAA) 比率（以下简称 Cho/NAA 比率）升高，以及它们的体积是否与胶质母细胞瘤 (GBM) 患者的无进展生存期 (PFS) 和总生存期 (OS) 相关。 材料和方法：这项回顾性分析得到了当地研究伦理委员会的批准。对 43 名经组织学证实的 GBM 患者的影像数据进行了体积分析。患者术前接受了常规、弥散加权、灌注加权和光谱序列的 3-T 磁共振成像。患者接受了随后的手术以及辅助化疗和放射治疗。在对比度增强和非增强区域中生成重叠的低 ADC 和高 rCBV 感兴趣区域 (ROI)（以下称为 ADC-rCBV ROI）。通过方差分析，将 ADC-rCBV ROI 中的 Cho/NAA 比率与对照区域中的比率进行比较。通过使用多变量 Cox 回归，所有所得 ROI 体积与患者生存率相关。结果：对比增强区域和非增强区域内的 ADC-rCBV ROI 显示 Cho/NAA 比率升高，该比率显着高于其他异常肿瘤区域（对比增强区域和非增强区域分别为 P < .001 和 P = .008）和正常白质（对比增强区域和非增强区域分别为 P < .001 和 P < .001）。对比度增强和非增强区域）。在控制年龄、肿瘤大小、切除范围、O-6-甲基鸟嘌呤-DNA甲基转移酶甲基化和异柠檬酸脱氢酶突变状态的 Cox 回归分析后，非增强区域中 ADC-rCBV ROI 的比例体积对 OS（风险比，1.132；P = .026）和 PFS（风险比，1.454；P = .026）和 PFS（风险比，1.454；P = .026）的多变量模型有显着贡献。 .017).结论：GBM 非增强区域中 ADC-rCBV ROI 的体积分析可用于在考虑 GBM 患者结果的已知混杂因素后识别生存趋势较差的患者。
Purpose: To determine whether regions of low apparent diffusion coefficient (ADC) with high relative cerebral blood volume (rCBV) represented elevated choline (Cho)-to-N-acety-laspartate (NAA) ratio (hereafter, Cho/NAA ratio) and whether their volumes correlated with progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma (GBM).Materials and Methods: This retrospective analysis was approved by the local research ethics committee. Volumetric analysis of imaging data from 43 patients with histologically confirmed GBM was performed. Patients underwent preoperative 3-T magnetic resonance imaging with conventional, diffusion-weighted, perfusion-weighted, and spectroscopic sequences. Patients underwent subsequent surgery with adjuvant chemotherapy and radiation therapy. Overlapping low-ADC and high-rCBV regions of interest (ROIs) (hereafter, ADC-rCBV ROIs) were generated in contrast-enhancing and nonenhancing regions. Cho/NAA ratio in ADC-rCBV ROIs was compared with that in control regions by using analysis of variance. All resulting ROI volumes were correlated with patient survival by using multivariate Cox regression.Results: ADC-rCBV ROIs within contrast-enhancing and nonenhancing regions showed elevated Cho/NAA ratios, which were significantly higher than those in other abnormal tumor regions (P < .001 and P = .008 for contrast-enhancing and nonenhancing regions, respectively) and in normal-appearing white matter (P < .001 for both contrast-enhancing and nonenhancing regions). After Cox regression analysis controlling for age, tumor size, resection extent, O-6-methylguanine-DNA methyltransferase-methylation, and isocitrate dehydrogenase mutation status, the proportional volume of ADC-rCBV ROIs in nonenhancing regions significantly contributed to multivariate models of OS (hazard ratio, 1.132; P = .026) and PFS (hazard ratio, 1.454; P = .017).Conclusion: Volumetric analysis of ADC-rCBV ROIs in nonenhancing regions of GBM can be used to identify patients with poor survival trends after accounting for known confounders of GBM patient outcome.