Cuccarini Valeria, Erbetta A, Farinotti M, Cuppini L, Ghielmetti F, Pollo B, Di Meco F, Grisoli M, Filippini G, Finocchiaro G, Bruzzone M G, Eoli M
J Neurooncol. 2016 Jan;126(2):279-88. doi: 10.1007/s11060-015-1960-5.
MRI grading of grade II and III gliomas may have an important impact on treatment decisions. Occasionally,both conventional MRI (cMRI) and histology fail to clearly establish the tumour grade. Three cMRI features(no necrosis; no relevant oedema; absent or faint contrast enhancement) previously validated in 196 patients with supratentorial gliomas directed our selection of 68 suspected low-grade gliomas (LGG) that were also investigated by advanced MRI (aMRI), including perfusion weighted imaging (PWI), diffusion weighted imaging(DWI) and spectroscopy. All the gliomas had histopathological diagnoses. Sensitivity and specificity of cMRI preoperative diagnosis were 78.5 and 38.5 %, respectively, and 85.7 and 53.8 % when a MRI was included, respectively. ROC analysis showed that cut-off values of 1.29 for maximum rCBV, 1.69 for minimum rADC, 2.1 for rCho/Cr ratio could differentiate between LGG and HGG with a sensitivity of 61.5, 53.8, and 53.8 % and a specificity of 54.7, 43 and 64.3 %, respectively. A significantly longer OS was observed in patients with a maximum rCBV<1.46 and minimum rADC>1.69 (80 vs 55 months, p = 0.01; 80 vs 51 months, p = 0.002, respectively). This result was also confirmed when cases were stratified according to pathology (LGG vs HGG). The ability of a MRI to differentiate between LGG and HGG and to predict survival improved as the number of a MRI techniques considered increased. In a selected population of suspected LGG,classification by cMRI underestimated the actual fraction of HGG. aMRI slightly increased the diagnostic accuracy compared to histopathology. However, DWI and PWI were prognostic markers independent of histological grade.
II级和III级胶质瘤的MRI分级可能对治疗决策产生重要影响。偶尔，传统MRI（cMRI）和组织学检查都无法明确确定肿瘤分级。先前在196例幕上胶质瘤患者中验证的三个cMRI特征（无坏死；无相关水肿；无强化或强化微弱）指导我们选择了68例疑似低级别胶质瘤（LGG），这些病例也接受了包括灌注加权成像（PWI）、扩散加权成像（DWI）和波谱分析在内的高级MRI（aMRI）检查。所有胶质瘤均有组织病理学诊断。cMRI术前诊断的敏感性和特异性分别为78.5%和38.5%，纳入aMRI后分别为85.7%和53.8%。ROC分析显示，最大rCBV为1.29、最小rADC为1.69、rCho/Cr比值为2.1时可区分LGG和HGG，敏感性分别为61.5%、53.8%和53.8%，特异性分别为54.7%、43%和64.3%。最大rCBV<1.46且最小rADC>1.69的患者观察到显著更长的总生存期（分别为80个月对55个月，p = 0.01；80个月对51个月，p = 0.002）。根据病理分层（LGG对HGG）时该结果也得到证实。随着所考虑的aMRI技术数量增加，aMRI区分LGG和HGG以及预测生存的能力提高。在选定的疑似LGG人群中，cMRI分类低估了HGG的实际比例。与组织病理学相比，aMRI略微提高了诊断准确性。然而，DWI和PWI是独立于组织学分级的预后标志物。
