Cha J, Kim S T, Kim H-J, Kim B-J, Kim Y K, Lee J Y, Jeon P, Kim K H, Kong D-S, Nam D-H
From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.).
From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
AJNR Am J Neuroradiol. 2014 Jul;35(7):1309-17. doi: 10.3174/ajnr.A3876. Epub 2014 Mar 27.
The multiparametric imaging can show us different aspects of tumor behavior and may help differentiation of tumor recurrence from treatment related change. Our aim was to differentiate tumor progression from pseudoprogression in patients with glioblastoma by using multiparametric histogram analysis of 2 consecutive MR imaging studies with relative cerebral blood volume and ADC values.
Thirty-five consecutive patients with glioblastoma with new or increased size of enhancing lesions after concomitant chemoradiation therapy following surgical resection were included. Combined histograms were made by using the relative cerebral blood volume and ADC values of enhancing areas for initial and follow-up MR imaging, and subtracted histograms were also prepared. The histogram parameters between groups were compared. The diagnostic accuracy of tumor progression based on the histogram parameters of initial and follow-up MR imaging and subtracted histograms was compared and correlated with overall survival.
Twenty-four pseudoprogressions and 11 tumor progressions were determined. Diagnosis based on the subtracted histogram mode with a multiparametric approach was more accurate than the diagnosis based on the uniparametric approach (area under the receiver operating characteristic curve of 0.877 versus 0.801), with 81.8% sensitivity and 100% specificity. A high mode of relative cerebral blood volume on the subtracted histogram by using a multiparametric approach (relative cerebral blood volume ×ADC) was the best predictor of true tumor progression (P < .001) and worse survival (P = .003).
Multiparametric histogram analysis of posttreatment glioblastoma was useful to predict true tumor progression and worse survival.
多参数成像能够向我们展示肿瘤行为的不同方面，可能有助于鉴别肿瘤复发与治疗相关改变。我们的目的是通过对连续2次磁共振成像（MR）研究的相对脑血容量和表观扩散系数（ADC）值进行多参数直方图分析，来鉴别胶质母细胞瘤患者的肿瘤进展与假性进展。
纳入35例手术切除后同步放化疗后强化病灶新发或增大的胶质母细胞瘤患者。利用初始和随访MR成像强化区域的相对脑血容量和ADC值制作联合直方图，同时也制备相减直方图。比较组间直方图参数。比较基于初始和随访MR成像直方图参数及相减直方图的肿瘤进展诊断准确性，并与总生存期进行相关性分析。
确定了24例假性进展和11例肿瘤进展。基于多参数方法的相减直方图模式诊断比基于单参数方法的诊断更准确（受试者操作特征曲线下面积分别为0.877和0.801），灵敏度为81.8%，特异性为100%。采用多参数方法（相对脑血容量×ADC）的相减直方图上相对脑血容量的高模式是真正肿瘤进展的最佳预测指标（P <.001），且与较差的生存期相关（P =.003）。
治疗后胶质母细胞瘤的多参数直方图分析有助于预测真正的肿瘤进展和较差的生存期。
