Gui Chloe, Lau Jonathan C, Kosteniuk Suzanne E, Lee Donald H, Megyesi Joseph F
Department of Clinical Neurological Sciences (Neurosurgery), Schulich School of Medicine & Dentistry, London, Canada.
London Health Sciences Centre, University Hospital, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
Acta Neurochir (Wien). 2019 Mar;161(3):569-576. doi: 10.1007/s00701-018-03783-3. Epub 2019 Feb 13.
An important aspect in the management of patients with diffuse low-grade gliomas (LGGs) involves monitoring the lesions via serial magnetic resonance imaging (MRI). However, radiological interpretations of LGG interval scans are often qualitative and thus difficult to use clinically.
To contextualize these assessments, we retrospectively compared radiological interpretations of LGG growth or stability to volume change measured by manual segmentation. Tumor diameter was also measured in one, two, and three dimensions to evaluate reported methods for assessment of glioma progression, including RECIST criteria, Macdonald/RANO criteria, and mean tumor diameter/ellipsoid method.
Tumors evaluated as stable by radiologists grew a median volume of 5.1 mL (11.1%) relative to the comparison scan, and those evaluated as having grown had a median volume increase of 13.3 mL (23.7%). Diameter-based measurements corresponded well but tended to overestimate gold standard segmented volumes. In addition, agreement with segmented volume measurements improved from 17.6 ± 8.0 to 4.5 ± 5.8 to 3.9 ± 3.6 mm for diameter and from 104.0 ± 96.6 to 25.3 ± 36.8 to 15.9 ± 21.3 mL for volume with radiological measurements in one, two, and three dimensions, respectively. Measurement overestimation increased with tumor size.
Given accumulating evidence that LGG volume and growth are prognostic factors, there is a need for objective lesion measurement. Current radiological reporting workflows fail to appreciate and communicate the true expansion of LGGs. While volumetric analysis remains the gold standard for assessment of growth, careful diametric measurements in three dimensions may be an acceptable alternative.
弥漫性低级别胶质瘤（LGG）患者管理的一个重要方面是通过系列磁共振成像（MRI）监测病灶。然而，LGG间隔扫描的放射学解读通常是定性的，因此在临床中难以应用。
为了使这些评估更具背景意义，我们回顾性地将LGG生长或稳定的放射学解读与通过手动分割测量的体积变化进行比较。还在一维、二维和三维上测量肿瘤直径，以评估报告的评估胶质瘤进展的方法，包括RECIST标准、Macdonald/RANO标准和平均肿瘤直径/椭球体法。
放射科医生评估为稳定的肿瘤相对于对照扫描的中位体积增长了5.1 mL（11.1%），而评估为生长的肿瘤中位体积增加了13.3 mL（23.7%）。基于直径的测量结果与之相符，但往往高估了金标准分割体积。此外，对于直径，与分割体积测量的一致性从一维放射学测量的17.6±8.0 mm提高到二维的4.5±5.8 mm，再到三维的3.9±3.6 mm；对于体积，从一维放射学测量的104.0±96.6 mL提高到二维的25.3±36.8 mL，再到三维的15.9±21.3 mL。测量高估随着肿瘤大小增加。
鉴于越来越多的证据表明LGG体积和生长是预后因素，需要进行客观的病灶测量。当前的放射学报告工作流程未能认识到并传达LGG的真实扩展情况。虽然体积分析仍然是评估生长的金标准，但仔细的三维直径测量可能是一种可接受的替代方法。
