Jamjoom A A B, Rodriguez D, Rajeb A T, Manita M A, Shah K A, Auer D P
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Clin Radiol. 2015 Dec;70(12):1400-7. doi: 10.1016/j.crad.2015.08.006. Epub 2015 Sep 26.
To investigate the prognostic power of intra-tumoural and gradient magnetic resonance imaging (MRI) diffusion metrics in patients with glioblastoma multiforme (GBM).
Forty-six consecutive patients with histologically confirmed GBM who had undergone preoperative diffusion tensor imaging at 3 T were included. Mean diffusivity (MD) and MD gradient maps were computed. Regions of interest were analysed to determine the minimum MD within the enhancing tumour (minMD). MD gradients were calculated along the enhancing tumour boundary and subjected to histogram analysis. Overall survival (OS) and time to progression (TTP) were derived and survival analysis was undertaken.
There were 31 deaths and 37 patients progressed during the study period. Multivariate survival analysis, controlling for treatment and gender, showed that minMD values<6.1×10(-4) mm(2)/s predicted shorter OS (hazard ratio [HR]=2.82, 1.25-6.34; p=0.012) and TTP (HR=5.43, 1.96-15.05; p=0.001). Higher MD gradient values of the tumour boundary predicted shorter survival: MD gradient values >4.7×10(-5) mm(2)/s (10(th) centile) had a significantly shorter OS with a HR of 0.43 (0.19-0.96; p=0.04). Similarly, a value above 1.4×10(-4) mm(2)/s (75(th) centile) was a significant predictor for shorter OS (HR=0.39, 0.17-0.89; p=0.03).
Lower minMD and higher MD gradient values for the 10(th) and 75(th) percentile of the tumour boundary demonstrated prognostic value in preoperative GBM. This suggests that MRI diffusion metrics indicative of higher focal cellularity and steeper transition from high cellular tumour edge to low cellular oedema define more aggressive glioblastoma subtypes with a poorer prognosis.
探讨多形性胶质母细胞瘤（GBM）患者瘤内及梯度磁共振成像（MRI）扩散指标的预后价值。
纳入46例经组织学确诊为GBM且术前行3T扩散张量成像的连续患者。计算平均扩散率（MD）和MD梯度图。分析感兴趣区域以确定强化肿瘤内的最小MD（minMD）。沿强化肿瘤边界计算MD梯度并进行直方图分析。得出总生存期（OS）和疾病进展时间（TTP）并进行生存分析。
研究期间有31例死亡，37例患者病情进展。多因素生存分析在控制治疗和性别后显示，minMD值<6.1×10⁻⁴mm²/s预测OS较短（风险比[HR]=2.82，1.25 - 6.34；p = 0.012）和TTP较短（HR = 5.43，1.96 - 15.05；p = 0.001）。肿瘤边界较高的MD梯度值预测生存期较短：MD梯度值>4.7×10⁻⁵mm²/s（第10百分位数）的OS明显较短，HR为0.43（0.19 - 0.96；p = 0.04）。同样，高于1.4×10⁻⁴mm²/s（第75百分位数）的值是OS较短的显著预测指标（HR = 0.39，0.17 - 0.89；p = 0.03）。
肿瘤边界第10和第75百分位数的较低minMD和较高MD梯度值在术前GBM中具有预后价值。这表明，提示更高局灶性细胞密度以及从高细胞肿瘤边缘到低细胞水肿更陡峭转变的MRI扩散指标定义了侵袭性更强、预后更差的胶质母细胞瘤亚型。
