Mohsen L A, Shi V, Jena R, Gillard J H, Price S J
Department of Radiology, University of Cambridge , Cambridge , UK.
Br J Neurosurg. 2013 Aug;27(4):436-41. doi: 10.3109/02688697.2013.771136. Epub 2013 Feb 27.
Glioblastomas multiformes (GBM) remain incurable in most cases. Their invasion into normal brain makes current therapies ineffective. Post-mortem studies suggest about a 25% of GBMs invade less than 1 cm from the tumour bulk and 20% invade more than 3 cm.
The study aims to use DTI to assess tumour extension and determine how previously reported patterns relate to the progression-free survival (PFS).
Twenty-five patients with GBM treated according to the EORTC/NCIC protocol were retrospectively analysed. Patients were imaged post-operatively at 1.5 T. The sequences were composed of standard anatomical and a standard DTI sequence. As described earlier p and q maps were constructed. For each of the p and q maps, regions of interest were drawn around the visible abnormality. Patients were assigned a diffuse, localised or minimally invasive pattern. Progression was defined according to the RANO criteria (4) and PFS determined in days. Kaplan-Meier plots of survival for the three groups were plotted as were the proportion of patients who had not progressed at 24 months.
The median PFS for the diffuse group was 278 days, for the localised group 605 days and 820 days for the minimally invasive group. Three-fourth of the minimally invasive group were progression-free at 24 months (LOG RANK 9.25; p = 0.010).
It is possible to identify three invasive phenotypes in GBMs using Diffusion tensor imaging , and these three phenotypes have different progression free survival. A minimal phenotype (20% of patients) predicts a greater delay to progression.
多形性胶质母细胞瘤（GBM）在大多数情况下仍无法治愈。它们侵入正常脑组织使得当前治疗方法无效。尸检研究表明，约25%的GBM从肿瘤主体侵入距离小于1厘米，20%侵入距离大于3厘米。
本研究旨在使用扩散张量成像（DTI）评估肿瘤扩展情况，并确定先前报道的模式与无进展生存期（PFS）之间的关系。
对按照欧洲癌症研究与治疗组织/加拿大国立癌症研究所（EORTC/NCIC）方案治疗的25例GBM患者进行回顾性分析。患者术后在1.5T磁场下进行成像。序列包括标准解剖序列和标准DTI序列。如前所述构建p图和q图。对于每个p图和q图，在可见异常周围绘制感兴趣区域。将患者分为弥漫型、局限型或微侵袭型模式。根据RANO标准（4）定义进展情况，并以天数确定PFS。绘制三组患者生存的Kaplan-Meier曲线以及24个月时未进展患者的比例。
弥漫型组的中位PFS为278天，局限型组为605天，微侵袭型组为820天。四分之三的微侵袭型组患者在24个月时无进展（对数秩检验9.25；p = 0.010）。
使用扩散张量成像可以在GBM中识别出三种侵袭性表型，并且这三种表型具有不同的无进展生存期。一种微侵袭表型（20%的患者）预示进展延迟时间更长。
