采用动态磁敏感对比 MRI 的独立成分分析测量血管变化可预测高级别胶质瘤对贝伐单抗的反应。
Vascular change measured with independent component analysis of dynamic susceptibility contrast MRI predicts bevacizumab response in high-grade glioma.
机构信息
Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
出版信息
Neuro Oncol. 2013 Apr;15(4):442-50. doi: 10.1093/neuonc/nos323. Epub 2013 Feb 3.
BACKGROUND
Standard pre- and postcontrast (T1 + C) anatomical MR imaging is proving to be insufficient for accurately monitoring bevacizumab treatment response in recurrent glioblastoma (GBM). We present a novel imaging biomarker that detects abnormal tumor vasculature exhibiting both arterial and venous perfusion characteristics. We hypothesized that a decrease in the extent of this abnormal vasculature after bevacizumab treatment would predict treatment efficacy and overall survival.
METHODS
Dynamic susceptibility contrast perfusion MRI was gathered in 43 patients with high-grade glioma. Independent component analysis separated vasculature into arterial and venous components. Voxels with perfusion characteristics of both arteries and veins (ie, arterio-venous overlap [AVOL]) were measured in patients with de novo untreated GBM and patients with recurrent high-grade glioma before and after bevacizumab treatment. Treated patients were separated on the basis of an increase or decrease in AVOL volume (+/-ΔAVOL), and overall survival following bevacizumab onset was then compared between +/-ΔAVOL groups.
RESULTS
AVOL in untreated GBM was significantly higher than in normal vasculature (P < .001). Kaplan-Meier survival curves revealed a greater median survival (348 days) in patients with GBM with a negative ΔAVOL after bevacizumab treatment than in patients with a positive change (197 days; hazard ratio, 2.51; P < .05). Analysis of patients with combined grade III and IV glioma showed similar results, with median survivals of 399 days and 153 days, respectively (hazard ratio, 2.71; P < .01). Changes in T1+C volume and ΔrCBV after treatment were not significantly different across +/-ΔAVOL groups, and ΔAVOL was not significantly correlated with ΔT1+C or ΔrCBV.
CONCLUSIONS
The independent component analysis dynamic susceptibility contrast-derived biomarker AVOL adds additional information for determining bevacizumab treatment efficacy.
背景
标准的 T1 增强前后（T1+C）解剖磁共振成像已被证明不足以准确监测贝伐单抗治疗复发性胶质母细胞瘤（GBM）的疗效。我们提出了一种新的成像生物标志物，用于检测具有动脉和静脉灌注特征的异常肿瘤血管。我们假设，贝伐单抗治疗后这种异常血管的范围减少将预测治疗效果和总生存期。
方法
对 43 例高级别胶质瘤患者进行动态磁敏感对比灌注 MRI 采集。独立成分分析将血管分为动脉和静脉成分。在未经治疗的新诊断 GBM 患者和复发性高级别胶质瘤患者中，测量具有动脉和静脉灌注特征的体素（即动静脉重叠[AVOL]）。根据 AVOL 体积的增加或减少（+/-ΔAVOL）对接受治疗的患者进行分组，然后比较贝伐单抗起始后 +/-ΔAVOL 组的总生存期。
结果
未经治疗的 GBM 中的 AVOL 明显高于正常血管（P<0.001）。Kaplan-Meier 生存曲线显示，贝伐单抗治疗后 AVOL 呈阴性变化的 GBM 患者的中位生存期（348 天）明显长于 AVOL 呈阳性变化的患者（197 天；风险比，2.51；P<0.05）。对合并 III 级和 IV 级胶质瘤的患者进行分析，结果相似，中位生存期分别为 399 天和 153 天（风险比，2.71；P<0.01）。治疗后 T1+C 体积和ΔrCBV 的变化在 +/-ΔAVOL 组之间没有显著差异，并且 AVOL 与ΔT1+C 或ΔrCBV 无显著相关性。
结论
独立成分分析动态磁敏感对比衍生的生物标志物 AVOL 为确定贝伐单抗治疗效果提供了额外的信息。
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