Moharamzad Yashar, Sanei Taheri Morteza, Niaghi Farhad, Shobeiri Elham
1 School of Medicine, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran.
2 Department of Radiology, Shohada Hospital, 48486 Shahid Beheshti University of Medical Sciences , Iran.
Neuroradiol J. 2018 Feb;31(1):10-17. doi: 10.1177/1971400917743099. Epub 2017 Nov 17.
Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R= 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) - 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.
目的 本文旨在研究脑干胶质瘤（BSG）的特定磁共振成像（MR）表现与组织病理学分级（低级别与高级别）之间的关联。方法 62例男性和34例女性（平均（标准差，SD）年龄24.61（17.20）岁，范围3至70岁）经组织学确诊为BSG，接受了常规1.5T MR成像，包括T1加权（T1W）、T2加权（T2W）和增强后T1W序列。其中有39名儿童（平均年龄9.38岁）和57名成人（平均年龄35岁）。采用二元逻辑回归分析来探讨MRI特征与BSG组织病理学分级之间的关联。结果 二元逻辑回归显示，坏死（调整优势比（OR）=16.07；95%置信区间（CI）=3.20至80.52；p=0.001）和不均匀强化（调整OR=8.04；95% CI=1.73至37.41；p=0.008）是高级别BSG的显著预测因素。方程（Nagelkerke R=0.575）为Logit（p高级别BSG）=（2.77×坏死）+（2.08×不均匀强化）-3.13。坏死的敏感性和特异性值分别为66.7%和96.0%，不均匀强化病变的敏感性和特异性值分别为85.7%和65.9%。在儿童年龄组中，只有不均匀强化（调整OR=40；95% CI=3.95至445.73；p=0.002）是高级别BSG的显著预测因素。结论 常规MR成像特征，如成人中的坏死和不均匀强化以及儿童中的不均匀强化提示高级别BSG。
