Distinguishing Recurrent High-grade Gliomas from Radiation Injury: A Pilot Study Using Dynamic Contrast-enhanced MR Imaging
Distinguishing Recurrent High-grade Gliomas from Radiation Injury: A Pilot Study Using Dynamic Contrast-enhanced MR Imaging
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DOI：
10.1016/j.acra.2011.01.018
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发表时间：
2011-05-01
影响因子：
4.8
通讯作者：
Ernemann, Ulrike
中科院分区：
文献类型：
--
作者：
Bisdas, Sotirios;Naegele, Thomas;Ernemann, Ulrike
基本原理和目标：准确描述肿瘤复发及其与放射损伤的鉴别是神经肿瘤学中的一个重要问题。本研究的目的是探讨是否来自动态对比增强（DCE）的T1加权磁共振成像（MRI）的血流动力学参数可以用来区分复发性胶质瘤放射necrosis.Materials和方法：18例胶质瘤治疗进行前瞻性的常规和DCE-MRI使用3 T扫描仪。药代动力学建模基于双室模型，该模型允许计算K-transs（血管内和血管外、细胞外空间之间的转移常数）、v（e）（血管外、细胞外空间）、k（ep）（从细胞外、血管外空间到血浆的转移常数）和iAUC（信号强度-时间曲线下初始面积）。在整个疑似复发的对比增强区域周围绘制感兴趣区域（ROI）。在随后的手术切除或临床放射学随访中确定了明确的诊断。结果：正常脑白质的K-transs、v（e）、k（ep）和iAUC值与放射性坏死脑白质和复发脑胶质瘤的K-transs、v（e）、k（ep）和iAUC值有显著性差异（0.01，< P <0.0001）。脑胶质瘤复发组与放射性坏死组血流动力学参数仅K-transs和iAUC有显著性差异，复发组明显高于放射性坏死组（P
Rationale and Objectives: The accurate delineation of tumor recurrence and its differentiation from radiation injury in the follow-up of adjuvantly treated high-grade gliomas presents a significant problem in neuro-oncology. The aim of this study was to investigate whether hemodynamic parameters derived from dynamic contrast-enhanced (DCE) T1-weighted magnetic resonance imaging (MRI) can be used to distinguish recurrent gliomas from radiation necrosis.Materials and Methods: Eighteen patients who were being treated for glial neoplasms underwent prospectively conventional and DCE-MRI using a 3T scanner. The pharmacokinetic modelling was based on a two-compartment model that allows for the calculation of K-trans (transfer constant between intra- and extravascular, extracellular space), v(e) (extravascular, extracellular space), k(ep) (transfer constant from the extracellular, extravascular Space into the plasma), and iAUC (initial area under the signal intensity-time curve). Regions of interest (ROIs) were drawn around the entire recurrence-suspected contrast-enhanced region. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. The hemodynamic parameters in the contralateral normal white matter, the radiation injury sites, and the tumor recurrent lesions were compared using nonparametric tests.Results: The K-trans, v(e), k(ep), and iAUC values in the normal white matter were significantly different than those in the radiation necrosis and recurrent gliomas (0.01, < P < .0001). The only significantly different hemodynamic parameter between the recurrent tumor lesions and the radiation-induced necrotic sites were K-trans and iAUC, which were significantly higher in the recurrent glioma group than in the radiation necrosis group (P