肿瘤放射组学异质性：多参数功能成像以描述宫颈癌放疗后变异性和预测反应。
Tumor radiomic heterogeneity: Multiparametric functional imaging to characterize variability and predict response following cervical cancer radiation therapy.
机构信息
University of Washington School of Medicine, Department of Radiation Oncology, Seattle, Washington, USA.
University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA.
出版信息
J Magn Reson Imaging. 2018 May;47(5):1388-1396. doi: 10.1002/jmri.25874. Epub 2017 Oct 16.
BACKGROUND
Robust approaches to quantify tumor heterogeneity are needed to provide early decision support for precise individualized therapy.
PURPOSE
To conduct a technical exploration of longitudinal changes in tumor heterogeneity patterns on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) and FDG positron emission tomography / computed tomography (PET/CT), and their association to radiation therapy (RT) response in cervical cancer.
STUDY TYPE
Prospective observational study with longitudinal MRI and PET/CT pre-RT, early-RT (2 weeks), and mid-RT (5 weeks).
POPULATION
Twenty-one FIGO IB -IVA cervical cancer patients receiving definitive external beam RT and brachytherapy.
FIELD STRENGTH/SEQUENCE: 1.5T, precontrast axial T -weighted, axial and sagittal T -weighted, sagittal DWI (multi-b values), sagittal DCE MRI (<10 sec temporal resolution), postcontrast axial T -weighted.
ASSESSMENT
Response assessment 1 month after completion of treatment by a board-certified radiation oncologist from manually delineated tumor volume changes.
STATISTICAL TESTS
Intensity histogram (IH) quantiles (DCE SI and DWI ADC , FDG-PET SUV ) and distribution moments (mean, variance, skewness, kurtosis) were extracted. Differences in IH features between timepoints and modalities were evaluated by Skillings-Mack tests with Holm's correction. Area under receiver-operating characteristic curve (AUC) and Mann-Whitney testing was performed to discriminate treatment response using IH features.
RESULTS
Tumor IH means and quantiles varied significantly during RT (SUV : ↓28-47%, SUV : ↓30-59%, SI : ↑8-30%, SI : ↑8-19%, ADC : ↑16%, P < 0.02 for each). Among IH heterogeneity features, FDG-PET SUV (↓16-30%, P = 0.011) and DW-MRI ADC decreased (P = 0.001). FDG-PET SUV was higher than DCE-MRI SI and DW-MRI ADC at baseline (P < 0.001) and 2 weeks (P = 0.010). FDG-PET SUV was lower than DCE-MRI SI and DW-MRI ADC at baseline (P = 0.001). Some IH features appeared to associate with favorable tumor response, including large early RT changes in DW-MRI ADC (AUC = 0.86).
DATA CONCLUSION
Preliminary findings show tumor heterogeneity was variable between patients, modalities, and timepoints. Radiomic assessment of changing tumor heterogeneity has the potential to personalize treatment and power outcome prediction.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1388-1396.
背景
需要稳健的方法来量化肿瘤异质性，以便为精准个体化治疗提供早期决策支持。
目的
对动态对比增强（DCE）磁共振成像（MRI）、弥散加权成像（DWI）和 FDG 正电子发射断层扫描/计算机断层扫描（PET/CT）上肿瘤异质性模式的纵向变化进行技术探索，并将其与宫颈癌放射治疗（RT）反应相关联。
研究类型
前瞻性观察性研究，包括 RT 前的纵向 MRI 和 PET/CT，早期 RT（2 周）和中期 RT（5 周）。
人群
21 名接受根治性外照射 RT 和近距离治疗的 FIGO IB-IVA 宫颈癌患者。
场强/序列：1.5T，预对比轴位 T1 加权、轴位和矢状位 T1 加权、矢状位 DWI（多 b 值）、矢状位 DCE MRI（<10 秒时间分辨率）、后对比轴位 T1 加权。
评估
由经过董事会认证的放射肿瘤学家从手动勾画的肿瘤体积变化来评估治疗完成后 1 个月的反应。
统计检验
提取强度直方图（IH）分位数（DCE SI 和 DWI ADC、FDG-PET SUV）和分布矩（均值、方差、偏度、峰度）。使用 Skillings-Mack 检验和 Holm 校正评估不同时间点和模态之间 IH 特征的差异。使用 IH 特征通过接收者操作特征曲线（AUC）和 Mann-Whitney 检验进行治疗反应的判别。
结果
肿瘤 IH 均值和分位数在 RT 期间发生显著变化（SUV：↓28-47%，SUV：↓30-59%，SI：↑8-30%，SI：↑8-19%，ADC：↑16%，P<0.02 每项）。在 IH 异质性特征中，FDG-PET SUV（↓16-30%，P=0.011）和 DW-MRI ADC 降低（P=0.001）。FDG-PET SUV 在基线时（P<0.001）和 2 周时（P=0.010）均高于 DCE-MRI SI 和 DW-MRI ADC。FDG-PET SUV 在基线时（P=0.001）低于 DCE-MRI SI。一些 IH 特征似乎与肿瘤的良好反应相关，包括 DW-MRI ADC 在早期 RT 中的大变化（AUC=0.86）。
数据结论
初步结果表明，肿瘤异质性在患者、模态和时间点之间存在差异。对变化的肿瘤异质性的放射组学评估有可能实现治疗个体化，并增强预后预测。
证据水平
2 技术功效：第 3 阶段 J. Magn. Reson. Imaging 2018;47:1388-1396.
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