Miyoshi Fuminori, Shinohara Yuki, Kambe Atsushi, Kuya Keita, Murakami Atsushi, Kurosaki Masamichi, Ogawa Toshihide
Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan.
Acta Radiol. 2018 Nov;59(11):1372-1379. doi: 10.1177/0284185118759707. Epub 2018 Feb 22.
Background Detecting recurrence of glioma on magnetic resonance imaging (MRI) is getting more and more important, especially after administration of new anti-tumor agent. However, it is still hard to identify. Purpose To examine the utility of intravoxel incoherent motion (IVIM) MRI and arterial spin labeling-cerebral blood flow (ASL-CBF) for recurrent glioma after initiation of bevacizumab (BEV) treatment. Material and Methods Thirteen patients (7 men, 6 women; age range = 41-82 years) with glioma (high grade, n = 11; low grade, n = 2) were enrolled in the study. IVIM parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), and perfusion fraction (f) were obtained with 14 different b-values. We identified tumor progression during BEV therapy by MRI monitoring consisting of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) imaging, and contrast-enhanced T1-weighted (CE-T1W) imaging by measuring tumor area. We also measured each parameter of IVIM and ASL-CBF, and calculated relative ADC (rADC), relative D (rD), relative f (rf), and relative CBF (rCBF) by obtaining the ratio between each area and the contralateral cerebral white matter. We calculated the rate of change (Δ) by subtracting values from those from the preceding MRI study, and obtained Spearman's rank correlation coefficient (rs). Results Tumor progression was identified in nine patients (high grade, n = 7; low grade, n = 2). Negative correlations were identified between ΔrD and ΔDWI area (rs = -0.583), and between ΔrD and ΔCE-T1W imaging area (rs = -0.605). Conclusion Tumor progression after BEV treatment can be identified by decreasing rD.
在磁共振成像（MRI）上检测胶质瘤复发变得越来越重要，尤其是在使用新型抗肿瘤药物之后。然而，复发仍然难以识别。目的：研究体素内不相干运动（IVIM）MRI和动脉自旋标记脑血流量（ASL-CBF）在贝伐单抗（BEV）治疗开始后对复发性胶质瘤的应用价值。材料与方法：13例胶质瘤患者（7例男性，6例女性；年龄范围=41-82岁）（高级别，n=11；低级别，n=2）纳入本研究。通过14个不同的b值获得包括表观扩散系数（ADC）、真实扩散系数（D）和灌注分数（f）在内的IVIM参数。我们通过由扩散加权成像（DWI）、液体衰减反转恢复（FLAIR）成像和对比增强T1加权（CE-T1W）成像组成的MRI监测，通过测量肿瘤面积来识别BEV治疗期间的肿瘤进展。我们还测量了IVIM和ASL-CBF的每个参数，并通过获得每个区域与对侧脑白质之间的比率来计算相对ADC（rADC）、相对D（rD）、相对f（rf）和相对CBF（rCBF）。我们通过用前一次MRI研究的值减去当前值来计算变化率（Δ），并获得斯皮尔曼等级相关系数（rs）。结果：9例患者（高级别，n=7；低级别，n=2）被识别出肿瘤进展。在ΔrD与ΔDWI面积之间（rs=-0.583）以及ΔrD与ΔCE-T1W成像面积之间（rs=-0.605）发现负相关。结论：BEV治疗后肿瘤进展可通过rD降低来识别。
