Shankar Jai Jai Shiva, Bata Adil, Ritchie Krista, Hebb Andrea, Walling Simon
1Department of Diagnostic Imaging,Division of Neuroradiology,Dalhousie University,Halifax.
2Interdisciplinary research team,IWK,Division of Neurosurgery,Dalhousie University,Halifax.
Can J Neurol Sci. 2016 Jan;43(1):127-33. doi: 10.1017/cjn.2015.356.
Glioblastoma multiforme (GBM) is known to have poor prognosis, with no available imaging marker that can predict survival at the time of diagnosis. Diffusion weighted images are used in characterisation of cellularity and necrosis of GBM. The purpose of this study was to assess whether pattern or degree of diffusion restriction could help in the prognostication of patients with GBM.
We retrospectively analyzed 84 consecutive patients with confirmed GBM on biopsy or resection. The study was approved by the institutional ethics committee. The total volume of the tumor and total volume of tumor showing restricted diffusion were calculated. The lowest Apparent Diffusion Coefficient (ADC) in the region of the tumor and in the contralateral Normal Appearing White Matter were calculated in order to calculate the nADC. Treatment and follow-up data in these patients were recorded. Multivariate analsysis was completed to determine significant correlations between different variables and the survival of these patients.
Patient survival was significantly related to the age of the patient (p<0.0001; 95% CI-1.022-1.043) and the nADC value (p=0.014; 95% CI-0.269-0.860) in the tumor. The correlation coefficients of age and nADC with survival were -0.335 (p=0.002) and 0.390 (p<0.001), respectively. Kaplan Meier survival function, grouped by normalized Apparent Diffusion Coefficient cut off value of 0.75, was significant (p=0.007).
The survival of patients with GBM had small, but significant, correlations with the patient's age and nADC within the tumor.
多形性胶质母细胞瘤（GBM）预后较差，在诊断时没有可用的影像学标志物能够预测生存情况。扩散加权成像用于GBM的细胞密度和坏死特征描述。本研究的目的是评估扩散受限的模式或程度是否有助于GBM患者的预后判断。
我们回顾性分析了84例经活检或切除确诊为GBM的连续患者。该研究获得了机构伦理委员会的批准。计算肿瘤的总体积和显示扩散受限的肿瘤总体积。计算肿瘤区域和对侧正常白质区域的最低表观扩散系数（ADC），以计算标准化表观扩散系数（nADC）。记录这些患者的治疗和随访数据。完成多变量分析以确定不同变量与这些患者生存之间的显著相关性。
患者生存与患者年龄（p<0.0001；95%可信区间-1.022-1.043）和肿瘤中的nADC值（p=0.014；95%可信区间-0.269-0.860）显著相关。年龄和nADC与生存的相关系数分别为-0.335（p=0.002）和0.390（p<0.001）。按标准化表观扩散系数截断值0.75分组的Kaplan Meier生存函数具有显著性（p=0.007）。
GBM患者的生存与患者年龄以及肿瘤内的nADC存在小但显著的相关性。
