Latysheva Anna, Emblem Kyrre Eeg, Server Andrés, Brandal Petter, Meling Torstein R, Pahnke Jens, Hald John K
From the Departments of Radiology.
Diagnostic Physics.
J Comput Assist Tomogr. 2018 Sep/Oct;42(5):807-815. doi: 10.1097/RCT.0000000000000742.
According to the new World Health Organization 2016 classification for tumors of the central nervous system, 1p/19q codeletion defines the genetic hallmark that differentiates oligodendrogliomas from diffuse astrocytomas. The aim of our study was to evaluate whether relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) histogram analysis can stratify survival in adult patients with genetic defined diffuse glioma grades II and III.
Sixty-seven patients with untreated diffuse gliomas World Health Organization grades II and III and known 1p/19q codeletion status were included retrospectively and analyzed using ADC and rCBV maps based on whole-tumor volume histograms. Overall survival and progression-free survival (PFS) were analyzed by using Kaplan-Meier and Cox survival analyses adjusted for known survival predictors.
Significant longer PFS was associated with homogeneous rCBV distribution-higher rCBVpeak (median, 37 vs 26 months; hazard ratio [HR], 3.2; P = 0.02) in patients with astrocytomas, and heterogeneous rCBV distribution-lower rCBVpeak (median, 46 vs 37 months; HR, 5.3; P < 0.001) and higher rCBVmean (median, 44 vs 39 months; HR, 7.9; P = 0.003) in patients with oligodendrogliomas. Apparent diffusion coefficient parameters (ADCpeak, ADCmean) did not stratify PFS and overall survival.
Tumors with heterogeneous perfusion signatures and high average values were associated with longer PFS in patients with oligodendrogliomas. On the contrary, heterogeneous perfusion distribution was associated with poor outcome in patients with diffuse astrocytomas.
根据世界卫生组织2016年中枢神经系统肿瘤新分类，1p/19q共缺失定义了将少突胶质细胞瘤与弥漫性星形细胞瘤区分开来的基因特征。我们研究的目的是评估相对脑血容量（rCBV）和表观扩散系数（ADC）直方图分析是否能对基因明确的成人II级和III级弥漫性胶质瘤患者的生存情况进行分层。
回顾性纳入67例未经治疗的世界卫生组织II级和III级弥漫性胶质瘤且已知1p/19q共缺失状态的患者，并基于全肿瘤体积直方图使用ADC和rCBV图进行分析。通过Kaplan-Meier法和经已知生存预测因素调整的Cox生存分析来分析总生存期和无进展生存期（PFS）。
在星形细胞瘤患者中，PFS显著延长与rCBV分布均匀-rCBV峰值较高相关（中位数，37对26个月；风险比[HR]，3.2；P = 0.02），而在少突胶质细胞瘤患者中，PFS显著延长与rCBV分布不均匀-rCBV峰值较低（中位数，46对37个月；HR，5.3；P < 0.001）和rCBV平均值较高（中位数，44对39个月；HR，7.9；P = 0.003）相关。表观扩散系数参数（ADC峰值、ADC平均值）未对PFS和总生存期进行分层。
少突胶质细胞瘤患者中，具有不均匀灌注特征和高平均值的肿瘤与更长的PFS相关。相反，弥漫性星形细胞瘤患者中，不均匀灌注分布与不良预后相关。
