Anselmi Monica, Catalucci Alessia, Felli Valentina, Vellucci Valentina, Di Sibio Alessandra, Gravina Giovanni Luca, Di Staso Mario, Di Cesare Ernesto, Masciocchi Carlo
1 Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila, Italy.
2 Division of Neuroradiology, Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy.
Neuroradiol J. 2017 Jun;30(3):240-252. doi: 10.1177/1971400916688354. Epub 2017 Jan 1.
Objectives The objective of this study was to evaluate whether proton magnetic resonance spectroscopy and perfusion magnetic resonance imaging (MRI) are able to increase diagnostic accuracy in the follow-up of brain gliomas, identifying the progression of disease before it becomes evident in the standard MRI; also to evaluate which of the two techniques has the best diagnostic accuracy. Methods Eighty-three patients with cerebral glioma (50 high-grade gliomas (HGGs), 33 low-grade gliomas (LGGs)) were retrospectively enrolled. All patients underwent standard MRI, H spectroscopic and perfusion echo-planar imaging MRI. For spectroscopy variations of choline/creatine, choline/N-acetyl-aspartate ratio, and lipids and lactates peak were considered. For perfusion 2.0 was considered the cerebral blood volume cut-off for progression. The combination of functional parameters gave a multiparametric score (0-2) to predict outcome. Diagnostic performance was determined by the receiver operating characteristic curve, with sensitivity, specificity, positive predictive and negative predictive values. Results In patients with LGGs a combined score of at least 1 was the best predictor for progression (odds ratio (OR) 3.91) with 8.4 months median anticipation of diagnosis compared to standard MRI. The individual advanced magnetic resonance technique did not show a diagnostic accuracy comparable to the combination of the two. Overall diagnostic accuracy area under the curve (AUC) was 0.881. In patients with HGGs the multiparametric score did not improve diagnostic accuracy significantly. Perfusion MRI was the best predictor of progression (OR 3.65), with 6.7 months median anticipation of diagnosis. Overall diagnostic accuracy AUC was 0.897. Then spectroscopy and perfusion MRI are able to identify tumour progression during follow-up earlier than standard MRI. Conclusion In patients with LGGs the combination of the functional parameters seems to be the best method for diagnosis of progression. In patients with HGGs perfusion is the best diagnostic method.
目的 本研究的目的是评估质子磁共振波谱和灌注磁共振成像（MRI）是否能够提高脑胶质瘤随访中的诊断准确性，在疾病进展在标准MRI中变得明显之前识别疾病进展；同时评估这两种技术中哪一种具有最佳诊断准确性。方法 回顾性纳入83例脑胶质瘤患者（50例高级别胶质瘤（HGG），33例低级别胶质瘤（LGG））。所有患者均接受标准MRI、氢质子磁共振波谱和灌注回波平面成像MRI检查。对于磁共振波谱，考虑胆碱/肌酸的变化、胆碱/N-乙酰天门冬氨酸比值以及脂质和乳酸峰。对于灌注，将脑血容量2.0视为进展的截断值。功能参数的组合给出一个多参数评分（0 - 2）以预测预后。通过受试者操作特征曲线确定诊断性能，包括灵敏度、特异度、阳性预测值和阴性预测值。结果 在LGG患者中，综合评分至少为1是进展的最佳预测指标（优势比（OR）3.91），与标准MRI相比，诊断提前的中位时间为8.4个月。单独的先进磁共振技术未显示出与两者组合相当的诊断准确性。曲线下总体诊断准确性面积（AUC）为0.881。在HGG患者中，多参数评分并未显著提高诊断准确性。灌注MRI是进展的最佳预测指标（OR 3.65），诊断提前的中位时间为6.7个月。总体诊断准确性AUC为0.897。因此，磁共振波谱和灌注MRI能够比标准MRI更早地在随访期间识别肿瘤进展。结论 在LGG患者中，功能参数的组合似乎是诊断进展的最佳方法。在HGG患者中，灌注是最佳诊断方法。
