酰胺质子转移加权磁共振成像引导下的立体定向活检在新诊断胶质瘤患者中的应用
Amide proton transfer-weighted magnetic resonance image-guided stereotactic biopsy in patients with newly diagnosed gliomas.
作者信息
Jiang Shanshan, Eberhart Charles G, Zhang Yi, Heo Hye-Young, Wen Zhibo, Blair Lindsay, Qin Huamin, Lim Michael, Quinones-Hinojosa Alfredo, Weingart Jon D, Barker Peter B, Pomper Martin G, Laterra John, van Zijl Peter C M, Blakeley Jaishri O, Zhou Jinyuan
机构信息
Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
出版信息
Eur J Cancer. 2017 Sep;83:9-18. doi: 10.1016/j.ejca.2017.06.009. Epub 2017 Jul 10.
PURPOSE
Pathological assessment using World Health Organization (WHO) criteria is the gold standard for diagnosis of gliomas. However, the accuracy of diagnosis is limited by tissue sampling, particularly for infiltrating, heterogeneous tumours. We assessed the accuracy of amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI)-guided tissue sampling to identify regions of high-grade glioma via radiographic-histopathologic correlation in patients with newly suspected glioma.
PATIENTS AND METHODS
Twenty-four patients with previously undiagnosed gliomas underwent a volumetric APTw MRI prior to their first neurosurgical procedure. A total of 70 specimens were collected via APTw image-directed stereotactic biopsy. Cellularity, necrosis, proliferation and glioma WHO grade were analysed for all specimens and correlated with corresponding APTw signal intensities.
RESULTS
Thirty-three specimens displayed grade-II pathology, 14 grade-III, 15 grade-IV, and eight specimens revealed only peritumoural oedema. Multiple glioma grades were found within a single lesion in six patients. APTw signal intensities of the biopsied sites and the maximum APTw values across all biopsied sites in each patient were significantly higher for high-grade versus low-grade specimens. APTw signal intensities were significantly positively correlated with cellularity (R = 0.757) and proliferation (R = 0.538). Multiple linear regression analysis showed that tumour cellularity and proliferation index were the best predictors of APTw signal intensities.
CONCLUSION
APTw imaging identified tumour areas of higher cellularity and proliferation, allowing identification of high-grade regions within heterogeneous gliomas. APTw imaging can be readily translated for more widespread use and can assist diagnostic neurosurgical procedures by increasing the accuracy of tumour sampling in patients with infiltrating gliomas.
目的
采用世界卫生组织（WHO）标准进行病理评估是胶质瘤诊断的金标准。然而，诊断的准确性受到组织采样的限制，特别是对于浸润性、异质性肿瘤。我们通过对新怀疑患有胶质瘤的患者进行影像学 - 组织病理学相关性分析，评估酰胺质子转移加权（APTw）磁共振成像（MRI）引导下组织采样以识别高级别胶质瘤区域的准确性。
患者与方法
24例先前未诊断出胶质瘤的患者在首次神经外科手术前接受了容积性APTw MRI检查。通过APTw图像引导的立体定向活检共采集了70个标本。对所有标本分析细胞密度、坏死情况、增殖情况以及胶质瘤的WHO分级，并将其与相应的APTw信号强度进行相关性分析。
结果
33个标本显示为II级病理，14个为III级，15个为IV级，8个标本仅显示瘤周水肿。6例患者的单个病灶内发现了多个胶质瘤级别。高级别标本的活检部位的APTw信号强度以及每位患者所有活检部位的最大APTw值均显著高于低级别标本。APTw信号强度与细胞密度（R = 0.757）和增殖（R = 0.538）显著正相关。多元线性回归分析表明，肿瘤细胞密度和增殖指数是APTw信号强度的最佳预测指标。
结论
APTw成像可识别细胞密度较高和增殖的肿瘤区域，从而在异质性胶质瘤中识别出高级别区域。APTw成像易于推广应用，并且通过提高浸润性胶质瘤患者肿瘤采样的准确性，可辅助诊断性神经外科手术。
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