Plathow Christian, Klopp Michael, Thieke Christian, Herth Felix, Thomas Andreas, Schmaehl Astrid, Zuna Ivan, Kauczor Hans-Ulrich
Department of Nuclearmedicine, University of Freiburg, Hugstetter 55, 79106, Freiburg, Germany.
Eur Radiol. 2008 Aug;18(8):1635-43. doi: 10.1007/s00330-008-0918-9. Epub 2008 Mar 28.
To evaluate and compare early therapy response according to RECIST (response evaluation criteria in solid tumours) and modified RECIST criteria using MRI techniques in patients with malignant pleural mesothelioma (MPM) in comparison with CT. Fifty patients with MPM (32 male/18 female) were included in this study. Early therapy response was evaluated after 9 weeks [three of six chemotherapy (CHT)] cycles. Additionally patients were examined before chemotherapy, 4 weeks after early therapy response evaluation and after six cycles to evaluate diagnostic follow-up. RECIST and modified RECIST criteria were applied using CT and MRI (HASTE, VIBE, T2-TSE sequences). In MRI additionally a volumetric approach measuring tumour weight (overall segmented tumour volume) was applied. Additionally vital capacity (VC) was measured for correlation. Image interpretation was performed by three independent readers independently and in consensus. The 'gold standard' was follow-up examination. Twenty-eight patients showed partial response, 12 patients stable disease and 10 patients progressive disease at early therapy response evaluation. In the follow-up these results remained. For MRI, in 46 cases patients were identically classified using RECIST and modified RECIST criteria. Modified RECIST criteria were identically classified as gold standards in all cases, whereas using RECIST criteria in four cases there was a mismatch (partial response vs. stable disease). Modified RECIST kappa values showed better interobserver variability compared with RECIST criteria (kappa=0.9-1.0 vs. 0.7-1.0). For CT, in 44 cases patients were identically classified using RECIST and modified RECIST criteria. Modified RECIST criteria were identically classified as in gold standards in 48 out of 50 patients, whereas using RECIST criteria in 6 cases there was a mismatch (partial response vs. stable disease). Modified RECIST kappa values showed better interobserver variability compared with RECIST criteria (kappa=0.9-1.0 vs. 0.6-1.0). Modified RECIST criteria especially in combination with high-resolution MRI is a very accurate and reproducible technique to correctly evaluate early therapy response in MPM.
采用磁共振成像（MRI）技术，根据实体瘤疗效评价标准（RECIST）和改良RECIST标准，评估和比较恶性胸膜间皮瘤（MPM）患者的早期治疗反应，并与计算机断层扫描（CT）进行比较。本研究纳入了50例MPM患者（32例男性/18例女性）。在9周[六个化疗（CHT）周期中的三个周期]后评估早期治疗反应。此外，在化疗前、早期治疗反应评估后4周以及六个周期后对患者进行检查，以评估诊断随访情况。使用CT和MRI（快速自旋回波序列、容积内插屏气检查序列、快速自旋回波T2加权序列）应用RECIST和改良RECIST标准。在MRI中，还采用了一种测量肿瘤重量（整体分割肿瘤体积）的容积法。此外，测量肺活量（VC）以进行相关性分析。由三名独立的阅片者独立且一致地进行图像解读。“金标准”为随访检查。在早期治疗反应评估中，28例患者显示部分缓解，12例患者病情稳定，10例患者病情进展。在随访中，这些结果保持不变。对于MRI，46例患者使用RECIST和改良RECIST标准的分类相同。改良RECIST标准在所有病例中均与金标准分类相同，而使用RECIST标准时，有4例存在不匹配（部分缓解与病情稳定）。与RECIST标准相比，改良RECIST标准的kappa值显示出更好的观察者间变异性（kappa = 0.9 - 1.0对0.7 - 1.0）。对于CT，44例患者使用RECIST和改良RECIST标准的分类相同。改良RECIST标准在50例患者中的48例中与金标准分类相同，而使用RECIST标准时，有6例存在不匹配（部分缓解与病情稳定）。与RECIST标准相比，改良RECIST标准的kappa值显示出更好的观察者间变异性（kappa = 0.9 - 1.0对0.6 - 1.0）。改良RECIST标准，尤其是与高分辨率MRI相结合，是一种非常准确且可重复的技术，可正确评估MPM的早期治疗反应。
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