Blasel Stella, Zagorcic Andrea, Jurcoane Alina, Bähr Oliver, Wagner Marlies, Harter Patrick N, Hattingen Elke
Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
J Neuroimaging. 2016 Jan-Feb;26(1):116-23. doi: 10.1111/jon.12247. Epub 2015 Apr 24.
Treatment-related changes (TRC) often imitate tumor progression in glioblastomas. Increased regional cerebral blood volume (rCBV) can differentiate tumor progression from TRC after the standardized first-line radiochemotherapy, but information about diagnostic accuracy of rCBV for patients without any clinical selection criteria is limited. Therefore, we aimed to evaluate if rCBV can differentiate between TRC and tumor progression irrespective of preceding therapies and number of tumor progressions.
We analyzed mean and maximum rCBV from the enhancing areas normalized to the contralateral white matter in 44 pretreated glioblastomas with MR-morphological tumor progression. The diagnosis (real progression vs. TRC) was determined by histopathology or by clinical/MRI-follow-up. We performed nonparametric tests, receiver operating characteristics (ROC), and Kaplan-Meier analysis.
Significant differences between tumor progression (N = 37) and TRC (N = 7) were found for rCBVmean (2.44 ± 1.05 vs. 1.69 ± .56, P < .03) and rCBVmax (3.40 ± 1.25 vs. 2.21 ± .62, P < .0007). A rCBVmax of 2.6 had 78% sensitivity and 86% specificity to detect tumor progression. Neither rCBVmean nor rCBVmax was predictive for the patient overall survival (OS). There were no statistically different rCBVmean and rCBVmax between the first and further tumor progressions.
The rCBVmax differentiates tumor progression from TRC in unselected recurrent glioblastomas, but it is not predictive for the OS.
治疗相关变化（TRC）常与胶质母细胞瘤的肿瘤进展相似。在标准化一线放化疗后，局部脑血容量（rCBV）增加可区分肿瘤进展与TRC，但关于无任何临床选择标准患者的rCBV诊断准确性的信息有限。因此，我们旨在评估rCBV能否区分TRC与肿瘤进展，而不考虑先前的治疗方法和肿瘤进展次数。
我们分析了44例经预处理且有MR形态学肿瘤进展的胶质母细胞瘤强化区域相对于对侧白质的平均和最大rCBV。诊断（真正进展与TRC）通过组织病理学或临床/MRI随访确定。我们进行了非参数检验、受试者工作特征（ROC）分析和Kaplan-Meier分析。
rCBVmean（2.44±1.05对1.69±0.56，P<.03）和rCBVmax（3.40±1.25对2.21±0.62，P<.0007）在肿瘤进展（N=37）和TRC（N=7）之间存在显著差异。rCBVmax为2.6时，检测肿瘤进展的敏感性为78%，特异性为86%。rCBVmean和rCBVmax均不能预测患者的总生存期（OS）。首次和后续肿瘤进展之间的rCBVmean和rCBVmax无统计学差异。
rCBVmax可区分未选择的复发性胶质母细胞瘤中的肿瘤进展与TRC，但不能预测OS。
