灌注对扩散峰度成像评估 2016 年 WHO 胶质瘤分级的影响：一项横断面观察性研究。
Effect of Perfusion on Diffusion Kurtosis Imaging Estimates for In Vivo Assessment of Integrated 2016 WHO Glioma Grades : A Cross-Sectional Observational Study.
机构信息
Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany.
Institute of Neuropathology, Department of Pathology and Neuropathology, Eberhard Karls University, Tübingen, Germany.
出版信息
Clin Neuroradiol. 2018 Dec;28(4):481-491. doi: 10.1007/s00062-017-0606-8. Epub 2017 Jul 12.
PURPOSE
To assess the role of perfusion-related signal decay on diffusion kurtosis imaging (DKI) estimates for in vivo stratification of glioma according to the integrated approach of the 2016 World Health Organization classification of tumors of the central nervous system (2016 CNS WHO).
METHODS
In this study 77 patients with histopathologically confirmed glioma were retrospectively assessed between January 2013 and February 2017 in a prospective trial. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two physicians blinded to the study from a volume of interest around the entire solid tumor. Wilcoxon's signed-rank test compared perfusion-biased and perfusion-corrected MK (MK and MK) and MD (MD, MD) values. One-way ANOVA was used to compare MK and MD values between 2016 WHO glioma grades. Spearman's correlation coefficient was used to correlate them with 2016 WHO glioma grades. Receiver operating characteristic (ROC) analysis was performed on MK and MD for the significant results.
RESULTS
The MK values were significantly higher than MK values (p < 0.001), whereas MD values were significantly lower than MD values (p < 0.001). For stratifying gliomas, MK values (ROC AUC range, 0.818-0.979) showed a higher diagnostic performance than MK values (ROC AUC range, 0.773-0.975), whereas MD values (ROC AUC range, 0.744-0.928) showed less diagnostic performance than MD values (ROC AUC range, 0.753-0.934). The diagnostic accuracy of MK was 80.0%.
CONCLUSION
The MK and MD estimates of DKI are influenced by microcapillary blood perfusion; however, taking the effect of perfusion on DKI metrics into account does not substantially impact their overall diagnostic performance in classifying glioma according to the 2016 CNS WHO.
目的
根据 2016 年世界卫生组织中枢神经系统肿瘤分类（2016 年 CNSWHO）的综合方法，评估灌注相关信号衰减对扩散峰度成像（DKI）估计值在活体胶质瘤分层中的作用。
方法
本研究回顾性评估了 2013 年 1 月至 2017 年 2 月期间在一项前瞻性试验中经组织病理学证实的 77 例胶质瘤患者。两名医生在不知道研究的情况下，从整个实体瘤的感兴趣区域评估 DKI 的平均峰度（MK）和平均弥散度（MD）指标。Wilcoxon 符号秩检验比较了灌注偏倚和校正 MK（MK 和 MK）和 MD（MD、MD）值。单因素方差分析用于比较 2016 年 WHO 胶质瘤分级之间的 MK 和 MD 值。Spearman 相关系数用于分析它们与 2016 年 WHO 胶质瘤分级的相关性。MK 和 MD 进行了显著结果的受试者工作特征（ROC）分析。
结果
MK 值明显高于 MK 值（p<0.001），而 MD 值明显低于 MD 值（p<0.001）。对于胶质瘤的分层，MK 值（ROC AUC 范围，0.818-0.979）的诊断性能高于 MK 值（ROC AUC 范围，0.773-0.975），而 MD 值（ROC AUC 范围，0.744-0.928）的诊断性能低于 MD 值（ROC AUC 范围，0.753-0.934）。MK 的诊断准确率为 80.0%。
结论
DKI 的 MK 和 MD 估计值受微血管血流灌注的影响；然而，考虑到灌注对 DKI 指标的影响，在根据 2016 年 CNSWHO 对胶质瘤进行分类时，它们的总体诊断性能并没有受到很大影响。
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