Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea.
Radiology. 2012 Sep;264(3):834-43. doi: 10.1148/radiol.12112120. Epub 2012 Jul 6.
To test the predictive value of skewness and kurtosis changes of normalized cerebral blood volume (nCBV) during the early treatment period for differentiating early tumor progression from pseudoprogression in patients with newly diagnosed glioblastomas.
The institutional review board approved this retrospective study. The authors assessed 135 patients with newly diagnosed glioblastomas who underwent concurrent chemotherapy and radiation therapy (CCRT) after surgical resection. Patients who developed new or enlarged contrast material-enhanced lesions after CCRT were assessed by means of conventional and perfusion magnetic resonance (MR) imaging. The percent change of skewness and kurtosis on nCBV histograms between the first and second post-CCRT follow-up were classified into four categories. Independent predictors of early tumor progression were determined by means of logistic regression analysis.
Of 135 patients, 79 had new or enlarged contrast-enhanced lesions after CCRT, subsequently classified as early tumor progression (n = 42, 53.2%) and pseudoprogression (n = 37, 46.8%). Pseudoprogression was observed in 23 of 24 (95.8%) patients in category 1, 10 of 15 (66.7%) in category 2, four of 20 (20.0%) in category 3, and 0 of 20 (0%) in category 4 (χ(2) test, P < .0001). The histographic pattern of nCBV was the best independent predictor (odds ratio, 3.51; P = .0032) for early tumor progression, rather than each percent change of skewness or kurtosis; the histographic pattern of nCBV represented the largest area under the receiver operating characteristic curve (0.934; 95% confidence interval: 0.855, 0.977), with a sensitivity of 85.7% and a specificity of 89.2%.
The percent change of skewness and kurtosis of nCBV may be a potential imaging biomarker for early treatment response in patients with newly diagnosed glioblastomas.
测试标准化脑血容量（nCBV）在早期治疗期间偏度和峰度变化对新诊断的胶质母细胞瘤患者早期肿瘤进展与假性进展进行区分的预测价值。
本研究经机构审查委员会批准，回顾性分析了 135 例接受手术切除后同步放化疗（CCRT）的新诊断为胶质母细胞瘤患者的资料。对 CCRT 后出现新的或增大的对比增强病变的患者行常规和灌注磁共振（MR）成像评估。通过 nCBV 直方图将 CCRT 后首次和第二次随访之间的偏度和峰度的百分比变化分为 4 类。采用逻辑回归分析确定早期肿瘤进展的独立预测因子。
在 135 例患者中，79 例患者在 CCRT 后出现新的或增大的对比增强病变，随后分为早期肿瘤进展（n = 42，53.2%）和假性进展（n = 37，46.8%）。在第 1 类中，24 例患者中有 23 例（95.8%）为假性进展，第 2 类中 15 例患者中有 10 例（66.7%）为假性进展，第 3 类中 20 例患者中有 4 例（20.0%）为假性进展，第 4 类中 20 例患者均为（0%）假性进展（卡方检验，P <.0001）。nCBV 的直方图形态是早期肿瘤进展的最佳独立预测因子（比值比，3.51；P =.0032），而不是偏度或峰度的每个百分比变化；nCBV 的直方图形态代表最大受试者工作特征曲线下面积（0.934；95%置信区间：0.855，0.977），其灵敏度为 85.7%，特异性为 89.2%。
nCBV 的偏度和峰度百分比变化可能是新诊断的胶质母细胞瘤患者早期治疗反应的潜在影像生物标志物。
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