Loganathan Amritraj G, Chan Michael D, Alphonse Natalie, Peiffer Ann M, Johnson Annette J, McMullen Kevin P, Urbanic James J, Saconn Paul A, Bourland J Daniel, Munley Michael T, Shaw Edward G, Tatter Stephen B, Ellis Thomas L
Department of Neurosurgery, Wake Forest University Health Sciences, Winston Salem, North Carolina, USA.
J Med Imaging Radiat Oncol. 2012 Oct;56(5):554-60. doi: 10.1111/j.1754-9485.2012.02429.x. Epub 2012 Jul 30.
The goal of this study was to determine if clinically relevant endpoints were changed by improved MRI resolution during radiosurgical treatment planning.
Between 2003 and 2008, 200 consecutive patients with brain metastases treated with Gamma Knife radiosurgery (GKRS) using either 1.5 T or 3.0 T MRI for radiosurgical treatment planning were retrospectively analysed. The number of previously undetected metastases at time of radiosurgery, distant brain failures, time delay to whole brain radiotherapy (WBRT), overall survival and likelihood of neurological death were determined.
Additional metastases were detected in 31.3% and 24.5% of patients at time of radiosurgery with 3.0 T and 1.5 T MRI, respectively (P = 0.27). Patients with multiple metastases at diagnostic scan were more likely to have additional metastases detected by 3.0 T MRI (P < 0.1). Median time to distant brain failure was 4.87 months and 5.43 months for the 3.0 T and 1.5 T cohorts, respectively (P = 0.44). Median time to WBRT was 5.8 months and 5.3 months for the 3.0 T and 1.5 T cohorts, respectively (P = 0.87). Median survival was 6.4 months for the 3.0 T cohort, and 6.1 months for the 1.5 T cohort (P = 0.71). Likelihood of neurological death was 25.3% and 16.7% for the 3.0 and 1.5 T populations, respectively (P = 0.26).
The 3.0 T MRI-based treatment planning for GKRS did not appear to affect the likelihood of distant brain failure, the need for WBRT or the likelihood of neurological death in this series.
本研究的目的是确定在放射外科治疗计划期间，提高MRI分辨率是否会改变临床相关终点。
回顾性分析了2003年至2008年间连续200例接受伽玛刀放射外科治疗（GKRS）的脑转移瘤患者，这些患者在放射外科治疗计划中使用1.5 T或3.0 T MRI。确定了放射外科手术时先前未检测到的转移瘤数量、远处脑转移、全脑放疗（WBRT）的时间延迟、总生存期和神经死亡的可能性。
在放射外科手术时，分别有31.3%和24.5%的患者通过3.0 T和1.5 T MRI检测到额外的转移瘤（P = 0.27）。诊断扫描时有多个转移瘤的患者更有可能通过3.0 T MRI检测到额外的转移瘤（P < 0.1）。3.0 T和1.5 T队列远处脑转移的中位时间分别为4.87个月和5.43个月（P = 0.44）。3.0 T和1.5 T队列WBRT的中位时间分别为5.8个月和5.3个月（P = 0.87）。3.0 T队列的中位生存期为6.4个月，1.5 T队列的中位生存期为6.1个月（P = 0.71）。3.0 T和1.5 T人群神经死亡的可能性分别为25.3%和16.7%（P = 0.26）。
在本系列研究中，基于3.0 T MRI的GKRS治疗计划似乎并未影响远处脑转移的可能性、WBRT的必要性或神经死亡的可能性。
