Ali Saad, Joseph Nancy M, Perry Arie, Barajas Ramon F, Cha Soonmee
Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, Room L-358, Box 0628, San Francisco, CA, 94143, USA,
J Neurooncol. 2014 Sep;119(2):353-60. doi: 10.1007/s11060-014-1485-3. Epub 2014 Jun 4.
Glioblastoma (GBM) with primitive neuroectodermal tumor (PNET)-like (GBM-PNET) components is a rare variant of GBM. Recent studies describe PNET-like clinical behavior in these patients-with significantly increased propensity for CSF dissemination and a benefit of "PNET-like" chemotherapy. The imaging appearance of GBM-PNET is not well-described and given areas of marked cellularity in the PNET components one might expect significantly reduced diffusion on MRI. The purpose of this study is to quantitatively evaluate the diffusion characteristics in GBM-PNET and compare them with conventional GBMs. Nine patients with surgical specimens yielding GBM-PNET were identified from the UCSF Pathology files. MR images of these patients were reviewed retrospectively. DWI (diffusion-weighted imaging) sequences were analyzed with multiple regions of interests placed within the tumor, and ADC (apparent diffusion coefficient) values were measured. Results were compared to previously published ADC values in pathology-proven conventional GBM cases from our institution. Reduced ADC was seen in GBM-PNET (mean 581 × 10(-6) mm(2)/s, range 338-817) compared to previously published mean of 1,030 × 10(-6) mm(2)/s in the enhancing components of conventional GBMs. We report substantially reduced ADC values in GBM-PNETs compared to conventional GBMs. If demonstrated in a larger sample, when areas of marked reduced diffusion are seen in a suspected GBM, MRI may appropriately direct tissue sampling and can advocate a thorough search for PNET-like components on histopathology. These patients may have a higher chance of developing CSF dissemination and may benefit from "PNET-like" platinum-based chemotherapy.
具有原始神经外胚层肿瘤(PNET)样成分的胶质母细胞瘤(GBM)是GBM的一种罕见变体。最近的研究描述了这些患者的PNET样临床行为——脑脊液播散倾向显著增加,且“PNET样”化疗有益。GBM-PNET的影像学表现描述不多,鉴于PNET成分中细胞显著密集的区域,人们可能预期其在MRI上扩散会显著降低。本研究的目的是定量评估GBM-PNET中的扩散特征,并将其与传统GBM进行比较。从加州大学旧金山分校病理学档案中识别出9例手术标本为GBM-PNET的患者。对这些患者的MR图像进行回顾性分析。在肿瘤内放置多个感兴趣区域分析扩散加权成像(DWI)序列,并测量表观扩散系数(ADC)值。结果与我们机构之前发表的经病理证实的传统GBM病例的ADC值进行比较。与之前发表的传统GBM强化成分中平均1030×10⁻⁶mm²/s相比,GBM-PNET中ADC降低(平均581×10⁻⁶mm²/s,范围338 - 817)。我们报告GBM-PNET的ADC值与传统GBM相比大幅降低。如果在更大样本中得到证实,当在疑似GBM中发现扩散显著降低的区域时,MRI可能适当地指导组织采样,并可主张在组织病理学上彻底寻找PNET样成分。这些患者发生脑脊液播散的可能性可能更高,可能从“PNET样”铂类化疗中获益。