Khan Usman A, Rennert Robert C, White Nathan S, Bartsch Hauke, Farid Nikdokht, Dale Anders M, Chen Clark C
Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA.
J Clin Neurosci. 2018 Dec;58:136-141. doi: 10.1016/j.jocn.2018.09.008. Epub 2018 Sep 22.
Discriminating between tumor recurrence and treatment effects in glioblastoma patients undergoing radiation-temozolomide (RT/TMZ) therapy remains a major clinical challenge. Here, we report a pilot study to determine the utility of restriction spectrum imaging (RSI), an advanced diffusion-weighted MRI (DWI) technique that affords meso-scale resolution of cell density, in this assessment. A retrospective review of 31 patients with glioblastoma treated between 2011 and 2017 who underwent surgical resection or biopsy over radiographic concern for tumor recurrence following RT/TMZ was performed. All patients underwent RSI prior to surgical resection. Diagnostic utility of RSI for tumor recurrence was determined in comparison to histopathology. Analysis of surgical specimens revealed treatment effects in 6/31 patients (19%) and tumor recurrence in 25/31 patients (81%). There was general concordance between the measured RSI signal and histopathologic diagnosis. RSI was negative in 5/6 patients (83%) in patients with histological evidence of treatment effects. RSI was positive in 21/25 patients (84%) in patients with tumor recurrence. The sensitivity, specificity, positive and negative predictive values of RSI for glioblastoma recurrence were 84%, 86%, 95%, and 60%, respectively. Histopathologic review showed agreement between the RSI signal and cellularity of the tumor specimen. These data support the use of RSI in the evaluation of treatment effects versus tumor recurrence in glioblastoma patients after RT-TMZ therapy.
在接受放疗-替莫唑胺（RT/TMZ）治疗的胶质母细胞瘤患者中，区分肿瘤复发和治疗效果仍然是一项重大的临床挑战。在此，我们报告一项初步研究，以确定限制谱成像（RSI）在该评估中的效用，RSI是一种先进的扩散加权磁共振成像（DWI）技术，可提供细胞密度的中尺度分辨率。对2011年至2017年间接受治疗的31例胶质母细胞瘤患者进行了回顾性研究，这些患者因担心RT/TMZ治疗后肿瘤复发而接受了手术切除或活检。所有患者在手术切除前均接受了RSI检查。将RSI对肿瘤复发的诊断效用与组织病理学进行了比较。对手术标本的分析显示，6/31例患者（19%）有治疗效果，25/31例患者（81%）有肿瘤复发。测量的RSI信号与组织病理学诊断总体一致。在有治疗效果组织学证据的患者中，5/6例患者（83%）的RSI为阴性。在有肿瘤复发的患者中，21/25例患者（84%）的RSI为阳性。RSI对胶质母细胞瘤复发的敏感性、特异性、阳性预测值和阴性预测值分别为84%、86%、95%和60%。组织病理学检查显示RSI信号与肿瘤标本的细胞密度一致。这些数据支持在评估RT-TMZ治疗后胶质母细胞瘤患者的治疗效果与肿瘤复发时使用RSI。
