Prager A J, Martinez N, Beal K, Omuro A, Zhang Z, Young R J
From the Departments of Radiology (A.J.P., R.J.Y.).
Neurology (N.M., A.O.).
AJNR Am J Neuroradiol. 2015 May;36(5):877-85. doi: 10.3174/ajnr.A4218. Epub 2015 Jan 15.
Treatment-related changes and recurrent tumors often have overlapping features on conventional MR imaging. The purpose of this study was to assess the utility of DWI and DSC perfusion imaging alone and in combination to differentiate treatment-related effects and recurrent high-grade gliomas.
We retrospectively identified 68 consecutive patients with high-grade gliomas treated by surgical resection followed by radiation therapy and temozolomide, who then developed increasing enhancing mass lesions indeterminate for treatment-related changes versus recurrent tumor. All lesions were diagnosed by histopathology at repeat surgical resection. ROI analysis was performed of the enhancing lesion on the ADC and DSC maps. Measurements made by a 2D ROI of the enhancing lesion on a single slice were recorded as ADCLesion and rCBVLesion, and measurements made by the most abnormal small fixed diameter ROI as ADCROI and rCBVROI. Statistical analysis was performed with Wilcoxon rank sum tests with P = .05.
Ten of the 68 patients (14.7%) had treatment-related changes, while 58 patients (85.3%) had recurrent tumor only (n = 19) or recurrent tumor mixed with treatment effect (n = 39). DWI analysis showed higher ADCLesion in treatment-related changes than in recurrent tumor (P = .003). DSC analysis revealed lower relative cerebral blood volume (rCBV)Lesion and rCBVROI in treatment-related changes (P = .003 and P = .011, respectively). Subanalysis of patients with suspected pseudoprogression also revealed higher ADCLesion (P = .001) and lower rCBVLesion (P = .028) and rCBVROI (P = .032) in treatment-related changes. Applying a combined ADCLesion and rCBVLesion model did not outperform either the ADC or rCBV metric alone.
Treatment-related changes showed higher diffusion and lower perfusion than recurrent tumor. Similar correlations were found for patients with suspected pseudoprogression.
在传统磁共振成像上，与治疗相关的改变和复发性肿瘤常常具有重叠的特征。本研究的目的是评估单独及联合应用扩散加权成像（DWI）和动态磁敏感对比增强灌注成像（DSC）来鉴别与治疗相关的效应和复发性高级别胶质瘤的效用。
我们回顾性纳入了68例连续的高级别胶质瘤患者，这些患者接受了手术切除，随后进行放射治疗和替莫唑胺治疗，之后出现了强化肿块病变增大，难以确定是与治疗相关的改变还是复发性肿瘤。所有病变均在再次手术切除时通过组织病理学确诊。对ADC图和DSC图上的强化病变进行感兴趣区（ROI）分析。在单个层面上对强化病变进行二维ROI测量，记录为ADCLesion和rCBVLesion，通过最异常的小固定直径ROI测量记录为ADCROI和rCBVROI。采用Wilcoxon秩和检验进行统计分析，P = 0.05。
68例患者中有10例（14.7%）出现与治疗相关的改变，而58例患者（85.3%）仅有复发性肿瘤（n = 19）或复发性肿瘤合并治疗效应（n = 39）。DWI分析显示，与治疗相关的改变相比，复发性肿瘤的ADCLesion更高（P = 0.003）。DSC分析显示，与治疗相关的改变中相对脑血容量（rCBV）Lesion和rCBVROI更低（分别为P = 0.003和P = 0.011）。对疑似假性进展患者的亚分析也显示，与治疗相关的改变中ADCLesion更高（P = 0.001），rCBVLesion和rCBVROI更低（分别为P = 0.028和P = 0.032）。应用联合ADCLesion和rCBVLesion模型的表现并不优于单独的ADC或rCBV指标。
与治疗相关的改变比复发性肿瘤表现出更高的扩散和更低的灌注。对于疑似假性进展的患者也发现了类似的相关性。
