Predicting the consistency of intracranial meningiomas using apparent diffusion coefficient maps derived from preoperative diffusion-weighted imaging
Predicting the consistency of intracranial meningiomas using apparent diffusion coefficient maps derived from preoperative diffusion-weighted imaging
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DOI：
10.3171/2020.6.jns20740
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发表时间：
2021-09-01
影响因子：
4.1
通讯作者：
Ogasawara, Kuniaki
中科院分区：
文献类型：
--
作者：
Miyoshi, Kenya;Wada, Tsukasa;Ogasawara, Kuniaki
目的脑膜瘤的质地是影响手术难度、手术并发症和手术时间的重要因素。表观扩散系数（ADC）来自扩散加权成像（DWI），并使用两个优化的B值计算。虽然标准ADC值与脑膜瘤一致性之间的比较结果各不相同，但已报告偏移ADC值与肝脏硬度密切相关。本前瞻性队列研究的目的是确定术前标准和偏移ADC图是否预测颅内脑膜瘤的一致性。方法在接受颅内脑膜瘤切除术的患者中，使用术前DWI计算标准（B值0和1000 sec/mm（2））和偏移（B值200和1500 sec/mm（2））ADC图。将感兴趣区域（ROI）放置在标准和移动ADC图上的肿瘤内，并在导航系统上进行配准。通过开颅手术切除位于配准ROI的肿瘤组织，并使用硬度计测量其刚度。确定最靠近受试者工作特征（ROC）曲线左上角的截止点，用于检测肿瘤硬度，以便始终需要超声吸引器或剪刀进行切除。结果25例患者的76个ROI中，硬度与标准ADC值（p =-0.465，p < 0.01）和偏移ADC值（p =-0.490，p < 0.01）呈显著负相关。检测硬肿瘤（硬度>= 20.8 kPa）的ROC曲线下面积在标准ADC（0.820）和偏移ADC（0.847）之间没有差异（p = 0.39）。低标准ADC和低偏移ADC联合检测硬肿瘤的阳性预测值（PPV）为89%。高标准ADC图与高位移ADC图联合应用对软肿瘤（硬度<20. 8 kPa）的检出率为81%。结论术前DWI的标准ADC图与位移ADC图联合应用可用于预测颅内脑膜瘤的一致性。
OBJECTIVE The consistency of meningiomas is a critical factor affecting the difficulty of resection, operative complications, and operative time. The apparent diffusion coefficient (ADC) is derived from diffusion-weighted imaging (DWI) and is calculated using two optimized b values. While the results of comparisons between the standard ADC and the consistency of meningiomas vary, the shifted ADC has been reported to be strongly correlated with liver stiffness. The purpose of the present prospective cohort study was to determine whether preoperative standard and shifted ADC maps predict the consistency of intracranial meningiomas.METHODS Standard (b values 0 and 1000 sec/mm(2)) and shifted (b values 200 and 1500 sec/mm(2)) ADC maps were calculated using preoperative DWI in patients undergoing resection of intracranial meningiomas. Regions of interest (ROIs) were placed within the tumor on standard and shifted ADC maps and registered on the navigation system. Tumor tissue located at the registered ROI was resected through craniotomy, and its stiffness was measured using a durometer. The cutoff point lying closest to the upper left corner of a receiver operating characteristic (ROC) curve was determined for the detection of tumor stiffness such that an ultrasonic aspirator or scissors was always required for resection. Each tumor tissue sample with stiffness greater than or equal to or less than this cutoff point was defined as hard or soft tumor, respectively.RESULTS For 76 ROIs obtained from 25 patients studied, significant negative correlations were observed between stiffness and the standard ADC (p = -0.465, p < 0.01) and the shifted ADC (p = -0.490, p < 0.01). The area under the ROC curve for detecting hard tumor (stiffness >= 20.8 kPa) did not differ between the standard ADC (0.820) and the shifted ADC (0.847) (p = 0.39). The positive predictive value (PPV) for the combination of a low standard ADC and a low shifted ADC for detecting hard tumor was 89%. The PPV for the combination of a high standard ADC and a high shifted ADC for detecting soft tumor (stiffness < 20.8 kPa) was 81%.CONCLUSIONS A combination of standard and shifted ADC maps derived from preoperative DWI can be used to predict the consistency of intracranial meningiomas.