Wang Yinyan, Wang Kai, Li Hongming, Wang Jiangfei, Wang Lei, Dai Jianping, Jiang Tao, Ma Jun
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Department of Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
PLoS One. 2015 Mar 30;10(3):e0121380. doi: 10.1371/journal.pone.0121380. eCollection 2015.
Contrast enhancement is a crucial radiologic feature of malignant brain tumors, which are associated with genetic changes of the tumor. The purpose of the current study was to investigate the potential relationship among tumor contrast enhancement with MR imaging, vascular endothelial growth factor (VEGF) expression, and survival outcome in anaplastic gliomas. MR images from 240 patients with histologically confirmed anaplastic gliomas were retrospectively analyzed. The volumes of T2 hyperintense, contrast enhanced regions and necrotic regions on postcontrast T1-weighted images were measured. The ratio of the enhanced volume to necrotic volume was compared between patients with high versus low levels of VEGF expression and was further used in the survival analysis. The volumetric ratio of enhancement to necrosis was significantly higher in patients with low VEGF expression than in those with high VEGF expression (Mann-Whitney, p = 0.009). In addition, the enhancement/necrosis ratio was identified as a significant predictor of progression-free survival (Cox regression model, p = 0.004) and overall survival (Cox regression model, p = 0.006) in the multivariate analysis. These results suggest that the volumetric ratio of enhancement to necrosis could serve as a noninvasive radiographic marker associated with VEGF expression and that this ratio is an independent predictor for progression-free survival and overall survival in patients with anaplastic gliomas.
对比增强是恶性脑肿瘤的一个关键影像学特征，其与肿瘤的基因改变相关。本研究的目的是探讨间变性胶质瘤中肿瘤对比增强与磁共振成像（MR）、血管内皮生长因子（VEGF）表达及生存结果之间的潜在关系。对240例经组织学证实为间变性胶质瘤患者的MR图像进行回顾性分析。测量对比剂增强后T1加权图像上T2高信号、对比增强区域及坏死区域的体积。比较VEGF表达水平高与低的患者增强体积与坏死体积之比，并将其进一步用于生存分析。VEGF表达水平低的患者增强与坏死的体积比显著高于VEGF表达水平高的患者（曼-惠特尼检验，p = 0.009）。此外，在多因素分析中，增强/坏死比被确定为无进展生存期（Cox回归模型，p = 0.004）和总生存期（Cox回归模型，p = 0.006）的显著预测指标。这些结果表明，增强与坏死的体积比可作为与VEGF表达相关的无创影像学标志物，且该比值是间变性胶质瘤患者无进展生存期和总生存期的独立预测指标。
