Predicting outcome of children with diffuse intrinsic pontine gliomas using multiparametric imaging
Predicting outcome of children with diffuse intrinsic pontine gliomas using multiparametric imaging
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DOI：
10.1093/neuonc/nor076
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发表时间：
2011-08-01
期刊：
影响因子：
15.9
通讯作者：
Warren, Katherine E.
中科院分区：
文献类型：
--
作者：
Hipp, Sean J.;Steffen-Smith, Emilie;Warren, Katherine E.
使用MRI进行无创性评估是常规评估儿童弥漫性桥脑胶质瘤(DIPGs)的主要手段。然而，没有标准的磁共振序列与这些患者的预后相关。在这项研究中，通过动态磁化率对比(DSC)MRI、单体素波谱(SVS)、多体素磁共振波谱(MRS)和T1加权后Gd成像来评估DIPGs患者的联合预后价值。符合条件的患者的临床和放射学结果与DIPG一致。在每个患者病程的不同时间点，在1.5TMRI上进行成像研究。使用COX比例风险模型、随时间变化的COX模型、Wald检验和Kaplan-Meier分析对数据进行评估。对34名中位年龄5.5岁的患者进行了98项研究。确诊后的中位生存期为468天。仅在基线成像时，SVS上胆碱/N-乙酰天冬氨酸比值(CHO：NAA)的增加和DSC-MRI上的灌注增加均预示着较短的生存期(相对风险分别为[RR]=1.48，P=0.015和RR=4.91，P=0.0012)。当分析所有后续时间点时，MRS上最大Cho：NAA增加(RR=1.45，P=0.042)，SVS上Cho：NAA增加(RR=1.69，P=0.003)，血流灌注增加(RR=4.68，P=0.0016)，以及有强化(RR=5.69，P=0.022)均预示着较短的生存时间。Kaplan-Meier分析显示，基线时血流灌注量增加与生存期缩短有关(P=.0004)。任何时间点的血流灌注量增加都预示着DIPG儿童的存活时间显著缩短。此外，强化、SVS上CHO：NAA的增加以及化学位移成像上最大CHO：NAA的增加预示着随着时间的推移生存期缩短。DIPG儿童的常规基线和后续成像至少应结合DSC-MRI和SVS。
Noninvasive evaluation using MRI is the primary means to routinely assess children with diffuse intrinsic pontine gliomas (DIPGs). However, no standard MR sequence has correlated with outcome in these patients. In this study, patients with DIPGs were assessed to determine the combined prognostic value via dynamic susceptibility contrast (DSC) MRI, single-voxel spectroscopy (SVS), multivoxel MR spectroscopy (MRS), and T1-weighted post-gadolinium imaging. Eligible patients had clinical and radiographic findings consistent with a DIPG. Imaging studies were acquired on a 1.5T MRI at various time points during each patient's course. Data were evaluated using a Cox proportional hazard model, a time-dependent covariant Cox model, a Wald test, and a Kaplan-Meier analysis. Ninety-eight studies were performed on 34 patients of median age 5.5 years. Median survival from diagnosis was 468 days. At baseline imaging only, increased ratio of choline to N-acetylaspartate (Cho:NAA) on SVS and increased perfusion on DSC-MRI each predicted shorter survival (relative risk [RR] = 1.48, P = .015 and RR = 4.91, P = .0012, respectively). When analyzing all subsequent time points, increased maximum Cho:NAA on MRS (RR = 1.45, P = .042), increased Cho:NAA on SVS (RR = 1.69, P = .003), increased perfusion (RR = 4.68, P = .0016), and the presence of enhancement (RR = 5.69, P = .022) each predicted shorter survival. Kaplan-Meier analysis showed shorter survival associated with increased perfusion at baseline (P = .0004). Increased perfusion at any time point predicts a significantly shorter survival in children with DIPG. In addition, enhancement, increased Cho:NAA on SVS, and increased maximum Cho:NAA on chemical shift imaging are predictive of shorter survival over time. Routine baseline and subsequent imaging for children with DIPG should, at minimum, incorporate DSC-MRI and SVS.