Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Lab Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
NMR Biomed. 2019 Feb;32(2):e4042. doi: 10.1002/nbm.4042. Epub 2018 Dec 17.
Accurate differentiation of true progression (TP) from pseudoprogression (PsP) in patients with glioblastomas (GBMs) is essential for planning adequate treatment and for estimating clinical outcome measures and future prognosis. The purpose of this study was to investigate the utility of three-dimensional echo planar spectroscopic imaging (3D-EPSI) in distinguishing TP from PsP in GBM patients. For this institutional review board approved and HIPAA compliant retrospective study, 27 patients with GBM demonstrating enhancing lesions within six months of completion of concurrent chemo-radiation therapy were included. Of these, 18 were subsequently classified as TP and 9 as PsP based on histological features or follow-up MRI studies. Parametric maps of choline/creatine (Cho/Cr) and choline/N-acetylaspartate (Cho/NAA) were computed and co-registered with post-contrast T -weighted and FLAIR images. All lesions were segmented into contrast enhancing (CER), immediate peritumoral (IPR), and distal peritumoral (DPR) regions. For each region, Cho/Cr and Cho/NAA ratios were normalized to corresponding metabolite ratios from contralateral normal parenchyma and compared between TP and PsP groups. Logistic regression analyses were performed to obtain the best model to distinguish TP from PsP. Significantly higher Cho/NAA was observed from CER (2.69 ± 1.00 versus 1.56 ± 0.51, p = 0.003), IPR (2.31 ± 0.92 versus 1.53 ± 0.56, p = 0.030), and DPR (1.80 ± 0.68 versus 1.19 ± 0.28, p = 0.035) regions in TP patients compared with those with PsP. Additionally, significantly elevated Cho/Cr (1.74 ± 0.44 versus 1.34 ± 0.26, p = 0.023) from CER was observed in TP compared with PsP. When these parameters were incorporated in multivariate regression analyses, a discriminatory model with a sensitivity of 94% and a specificity of 87% was observed in distinguishing TP from PsP. These results indicate the utility of 3D-EPSI in differentiating TP from PsP with high sensitivity and specificity.
准确地区分胶质母细胞瘤（GBM）患者的真性进展（TP）和假性进展（PsP）对于制定适当的治疗计划以及评估临床预后指标和未来预后至关重要。本研究旨在探讨三维 echo 平面波谱成像（3D-EPSI）在区分 GBM 患者的 TP 与 PsP 中的作用。这项经过机构审查委员会批准并符合 HIPAA 规定的回顾性研究纳入了 27 例在同步放化疗完成后 6 个月内出现增强病变的 GBM 患者。其中，18 例随后根据组织学特征或随访 MRI 研究被归类为 TP，9 例被归类为 PsP。计算了胆碱/肌酸（Cho/Cr）和胆碱/N-乙酰天门冬氨酸（Cho/NAA）的参数图，并与增强后 T1 加权和 FLAIR 图像进行配准。所有病变均被分割为增强区（CER）、即刻瘤周区（IPR）和远瘤周区（DPR）。对于每个区域，将 Cho/Cr 和 Cho/NAA 比值归一化为对侧正常脑实质的相应代谢物比值，并在 TP 和 PsP 组之间进行比较。进行逻辑回归分析以获得最佳模型，用于区分 TP 和 PsP。与 PsP 相比，TP 患者的 CER（2.69±1.00 与 1.56±0.51，p=0.003）、IPR（2.31±0.92 与 1.53±0.56，p=0.030）和 DPR（1.80±0.68 与 1.19±0.28，p=0.035）区域的 Cho/NAA 明显更高。此外，与 PsP 相比，TP 患者的 CER（1.74±0.44 与 1.34±0.26，p=0.023）的 Cho/Cr 也明显升高。当这些参数纳入多变量回归分析时，观察到一种具有 94%敏感性和 87%特异性的区分 TP 和 PsP 的判别模型。这些结果表明 3D-EPSI 在区分 TP 和 PsP 方面具有高敏感性和特异性。
