动态对比增强磁共振成像减法在评估骨肉瘤对化疗的反应中的应用

Dynamic contrast enhanced magnetic resonance imaging subtraction in evaluating osteosarcoma response to chemotherapy.

作者信息

Torricelli P, Montanari N, Spina V, Manfrini M, Bertoni F, Saguatti G, Romagnoli R

机构信息

Department of Radiology, University, Modena and Reggio Emilia, Policlinico, Via dal Pozzo 71, 41100 Modena MO.

出版信息

Radiol Med. 2001 Mar;101(3):145-51.

PMID:11402952

Abstract

PURPOSE

To evaluate the results of a new technique of dynamic contrast enhanced Magnetic Resonance (MR) imaging subtraction in the assessment of osteosarcoma response to chemotherapy.

METHODS

24 patients with high grade osteosarcoma, treated with preoperative neo-adjuvant chemotherapy, underwent MR at high field strength (1.5 T). Both unenhanced conventional SE T1- and T2-weighted sequences in the coronal and axial plane and dynamic Gd-DTPA-enhanced SE T1-weighted sequences in the coronal plane were performed. Image postprocessing included subtraction of unenhanced image from enhanced images (arbitrary called "angiographic subtraction") and subtraction of each enhanced image from the last-enhanced image (arbitrary called "pathologic area" subtraction). The early enhancing areas detected in the angiographic subtraction and the pathologic areas detected in the pathologic area subtraction were correlated with histopathological findings on histological macrosections obtained from the resected specimen. The sensitivity, specificity, accuracy, positive and negative predictive value of both the subtraction techniques were calculated.

RESULTS

The early enhancing areas of angiographic subtraction were related not only to viable tumor but also to the host reactions such as flogosis and granulation tissue. The pathologic areas detected at the pathologic area subtraction correlated in most cases with viable tumor, while in 3 cases they did not correspond to viable tumor tissue and in 1 case a small area of residual viable tumor was missed. In assessing response to chemotherapy, pathologic areas subtraction had an accuracy of 95% (specificity: 100%, sensitivity: 93%, PPV: 100%, NPV: 88%), whereas angiographic subtraction had an accuracy of 79% (specificity: 37%, sensitivity: 100%, PPV: 76%, NPV: 100%).

CONCLUSIONS

Pathologic area subtraction may be a useful technique for assessing the response of osteosarcoma to chemotherapy and for detecting residual viable tumor tissue.

摘要

目的

评估动态对比增强磁共振（MR）成像减影新技术在评估骨肉瘤化疗反应中的结果。

方法

24例接受术前新辅助化疗的高级别骨肉瘤患者在高场强（1.5T）下行MR检查。在冠状面和轴面进行了非增强常规SE T1加权和T2加权序列成像，以及在冠状面进行了动态钆喷酸葡胺增强SE T1加权序列成像。图像后处理包括从增强图像中减去非增强图像（任意称为“血管造影减影”），以及从最后增强图像中减去每个增强图像（任意称为“病理区域”减影）。血管造影减影中检测到的早期强化区域和病理区域减影中检测到的病理区域与从切除标本获得的组织学大体切片上的组织病理学结果相关。计算两种减影技术的敏感性、特异性、准确性、阳性和阴性预测值。

结果

血管造影减影的早期强化区域不仅与存活肿瘤有关，还与诸如炎症和肉芽组织等宿主反应有关。病理区域减影中检测到的病理区域在大多数情况下与存活肿瘤相关，而在3例中它们与存活肿瘤组织不对应，并且在1例中遗漏了一小片残留的存活肿瘤区域。在评估化疗反应时，病理区域减影的准确性为95%（特异性：100%，敏感性：93%，阳性预测值：100%，阴性预测值：88%），而血管造影减影的准确性为79%（特异性：37%，敏感性：100%，阳性预测值：76%，阴性预测值：100%）。