From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
Radiology. 2018 Jun;287(3):944-954. doi: 10.1148/radiol.2017170845. Epub 2018 Jan 19.
Purpose To determine if preoperative vascular heterogeneity of glioblastoma is predictive of overall survival of patients undergoing standard-of-care treatment by using an unsupervised multiparametric perfusion-based habitat-discovery algorithm. Materials and Methods Preoperative magnetic resonance (MR) imaging including dynamic susceptibility-weighted contrast material-enhanced perfusion studies in 50 consecutive patients with glioblastoma were retrieved. Perfusion parameters of glioblastoma were analyzed and used to automatically draw four reproducible habitats that describe the tumor vascular heterogeneity: high-angiogenic and low-angiogenic regions of the enhancing tumor, potentially tumor-infiltrated peripheral edema, and vasogenic edema. Kaplan-Meier and Cox proportional hazard analyses were conducted to assess the prognostic potential of the hemodynamic tissue signature to predict patient survival. Results Cox regression analysis yielded a significant correlation between patients' survival and maximum relative cerebral blood volume (rCBV) and maximum relative cerebral blood flow (rCBF) in high-angiogenic and low-angiogenic habitats (P < .01, false discovery rate-corrected P < .05). Moreover, rCBF in the potentially tumor-infiltrated peripheral edema habitat was also significantly correlated (P < .05, false discovery rate-corrected P < .05). Kaplan-Meier analysis demonstrated significant differences between the observed survival of populations divided according to the median of the rCBV or rCBF at the high-angiogenic and low-angiogenic habitats (log-rank test P < .05, false discovery rate-corrected P < .05), with an average survival increase of 230 days. Conclusion Preoperative perfusion heterogeneity contains relevant information about overall survival in patients who undergo standard-of-care treatment. The hemodynamic tissue signature method automatically describes this heterogeneity, providing a set of vascular habitats with high prognostic capabilities. RSNA, 2018.
目的 利用一种无监督的多参数灌注基栖息地发现算法,确定胶质母细胞瘤患者术前血管异质性是否可预测接受标准治疗患者的总生存情况。
材料与方法 回顾性分析 50 例连续胶质母细胞瘤患者的术前磁共振(MR)成像资料,包括动态磁敏感对比增强灌注研究。分析胶质母细胞瘤的灌注参数,并用于自动绘制 4 个可重复的描述肿瘤血管异质性的栖息地:增强肿瘤的高血管生成区和低血管生成区、潜在肿瘤浸润性周边水肿区和血管源性水肿区。采用 Kaplan-Meier 法和 Cox 比例风险分析评估血流动力学组织特征对预测患者生存的预后潜力。
结果 Cox 回归分析显示,患者的生存与高血管生成区和低血管生成区的最大相对脑血容量(rCBV)和最大相对脑血流量(rCBF)显著相关(P <.01,经假发现率校正的 P <.05)。此外,潜在肿瘤浸润性周边水肿区的 rCBF 也与患者的生存显著相关(P <.05,经假发现率校正的 P <.05)。Kaplan-Meier 分析显示,根据高血管生成区和低血管生成区 rCBV 或 rCBF 的中位数将患者分为不同人群,观察生存率存在显著差异(对数秩检验 P <.05,经假发现率校正的 P <.05),平均生存时间延长 230 天。
结论 术前灌注异质性包含接受标准治疗患者总生存情况的相关信息。血流动力学组织特征方法自动描述这种异质性,提供一组具有高预后能力的血管栖息地。
放射学学会,2018 年。