Yu Jing, Wang Min, Song Jiacheng, Huang DongYa, Hong Xunning
From the Departments of *Radiology and †General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Comput Assist Tomogr. 2016 Mar-Apr;40(2):301-6. doi: 10.1097/RCT.0000000000000352.
The aim of this study was to evaluate the predictive value of multivariate factors of Visually AcceSAble Rembrandt Images (VASARI) in brain astrocytoma grading.
Presurgical magnetic resonance images of 126 patients with brain astrocytomas (World Health Organization grade 2, n = 38; grade 3, n = 36; grade 4, n = 52) were rated by 2 neuroradiologists for tumor size, location, and tumor morphology by using a standardized imaging feature set VASARI.
Significant differences were noted in 12 factors of VASARI including enhancement quality, enhancing proportion, noncontrast enhancing tumor proportion, necrosis proportion, edema proportion, hemorrhage, thickness of enhancing margin, definition of the enhancing margin, pial and ependymal invasion, enhanced tumor crossing midline, and satellites between brain astrocytoma grades (grades 1-IV, P < 0.05). On multivariate regression analysis, enhancement quality was an independent diagnostic factor for high-grade brain astrocytoma, whereas edema proportion was an independent diagnostic factor in differentiating grade 2 and grade 3. Noncontrast enhancing tumor proportion was a predictive factor in the diagnosis of grade 4 astrocytoma. Receiver operating characteristic analysis illustrates edema proportion score higher than 2 with sensitivity of 86.1% in differentiating grade 2 and grade 3 astrocytoma. Noncontrast enhancing tumor proportion scores 4 or lower has high sensitivity (92.3%) but moderate specificity (50.0%) in differentiating grade 3 and grade 4 astrocytoma.
Our data illustrate that magnetic resonance features of VASARI especially enhancement quality, edema proportion, and noncontrast enhancing tumor proportion provided precise and detailed information of astrocytoma grading and suggested that prediction of astrocytoma grading is based on VASARI as an adjunct to biopsy.
本研究旨在评估视觉可及的伦勃朗图像（VASARI）多因素在脑星形细胞瘤分级中的预测价值。
两名神经放射科医生使用标准化成像特征集VASARI对126例脑星形细胞瘤患者（世界卫生组织2级，n = 38；3级，n = 36；4级，n = 52）的术前磁共振图像进行肿瘤大小、位置和肿瘤形态评分。
VASARI的12个因素在脑星形细胞瘤分级（1 - 4级）之间存在显著差异，包括强化质量、强化比例、无强化肿瘤比例、坏死比例、水肿比例、出血、强化边缘厚度、强化边缘清晰度、软脑膜和室管膜侵犯、强化肿瘤跨越中线以及卫星灶（P < 0.05）。多因素回归分析显示，强化质量是高级别脑星形细胞瘤的独立诊断因素，而水肿比例是鉴别2级和3级的独立诊断因素。无强化肿瘤比例是诊断4级星形细胞瘤的预测因素。受试者工作特征分析表明，水肿比例评分高于2分时，鉴别2级和3级星形细胞瘤的敏感性为86.1%。无强化肿瘤比例评分4分及以下时，鉴别3级和4级星形细胞瘤具有高敏感性（92.3%）但中等特异性（50.0%）。
我们的数据表明，VASARI的磁共振特征，尤其是强化质量、水肿比例和无强化肿瘤比例，提供了星形细胞瘤分级的精确详细信息，并提示基于VASARI预测星形细胞瘤分级可作为活检的辅助手段。
