van Dijken Bart R J, Yan Jiun-Lin, Boonzaier Natalie R, Li Chao, van Laar Peter Jan, van der Hoorn Anouk, Price Stephen J
Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
World Neurosurg. 2017 Sep;105:697-701. doi: 10.1016/j.wneu.2017.06.075. Epub 2017 Jun 20.
Glioblastomas have a poor prognosis, possibly because of a subpopulation of therapy-resistant stem cells within the heterogeneous glioblastoma. Because the subventricular zone is the main source of neural stem cells, we aimed at characterizing the subventricular zone using diffusion tensor imaging (DTI) to show subventricular zone involvement in glioblastoma.
We prospectively included 93 patients with primary glioblastomas who underwent preoperative DTI. The nonenhancing high fluid-attenuated inversion recovery (FLAIR) signal was used to describe the infiltrative tumor margin. We used a 5-mm margin surrounding the lateral ventricles to define the subventricular zone. The subventricular zone with high FLAIR was compared with the subventricular zone without high FLAIR, control high FLAIR outside the subventricular zone and control contralateral normal-appearing white matter. Normalized DTI parameters were calculated and compared between the different regions.
The subventricular zone with high FLAIR showed increased isotropic p values compared with the subventricular zone without high FLAIR (t = 3.9; P < 0.001) and control regions (t = 1.9; P = 0.046). Anisotropic q and fractional anisotropy values were lower in regions with high FLAIR compared with the subventricular zone without high FLAIR (t = 11.6, P < 0.001 and t =12.4, P < 0.001, respectively).
DTI data showed that the subventricular zone is involved in glioblastoma with increased isotropic p values in the subventricular zone with high FLAIR, indicating tumor infiltration.
胶质母细胞瘤预后较差，这可能是由于异质性胶质母细胞瘤中存在对治疗耐药的干细胞亚群。由于脑室下区是神经干细胞的主要来源，我们旨在通过弥散张量成像（DTI）对脑室下区进行特征描述，以显示胶质母细胞瘤中脑室下区受累情况。
我们前瞻性纳入了93例接受术前DTI检查的原发性胶质母细胞瘤患者。采用非增强高液体衰减反转恢复（FLAIR）信号来描述浸润性肿瘤边缘。我们使用围绕侧脑室5毫米的边缘来定义脑室下区。将具有高FLAIR信号的脑室下区与无高FLAIR信号的脑室下区、脑室下区外的对照高FLAIR区域以及对侧外观正常的白质进行比较。计算不同区域之间的标准化DTI参数并进行比较。
与无高FLAIR信号的脑室下区相比，具有高FLAIR信号的脑室下区各向同性p值增加（t = 3.9；P < 0.001），与对照区域相比也增加（t = 1.9；P = 0.046）。与无高FLAIR信号的脑室下区相比，具有高FLAIR信号的区域各向异性q值和分数各向异性值较低（分别为t = 11.6，P < 0.001和t = 12.4，P < 0.001）。
DTI数据显示，脑室下区参与了胶质母细胞瘤，具有高FLAIR信号的脑室下区各向同性p值增加，提示肿瘤浸润。
