Departments of1Neurological Surgery.
2Radiology, Division of Neuroradiology, Division of Molecular Imaging and Therapeutics; and.
Neurosurg Focus. 2019 Jun 1;46(6):E10. doi: 10.3171/2019.3.FOCUS1954.
OBJECTIVEThere is a need for advanced imaging biomarkers to improve radiation treatment planning and response assessment. T1-weighted dynamic contrast-enhanced perfusion MRI (DCE MRI) allows quantitative assessment of tissue perfusion and blood-brain barrier dysfunction and has entered clinical practice in the management of primary and secondary brain neoplasms. The authors sought to retrospectively investigate DCE MRI parameters in meningiomas treated with resection and adjuvant radiation therapy using volumetric segmentation.METHODSA retrospective review of more than 300 patients with meningiomas resected between January 2015 and December 2018 identified 14 eligible patients with 18 meningiomas who underwent resection and adjuvant radiotherapy. Patients were excluded if they did not undergo adjuvant radiation therapy or DCE MRI. Demographic and clinical characteristics were obtained and compared to DCE perfusion metrics, including mean plasma volume (vp), extracellular volume (ve), volume transfer constant (Ktrans), rate constant (kep), and wash-in rate of contrast into the tissue, which were derived from volumetric analysis of the enhancing volumes of interest.RESULTSThe mean patient age was 64 years (range 49-86 years), and 50% of patients (7/14) were female. The average tumor volume was 8.07 cm3 (range 0.21-27.89 cm3). The median Ki-67 in the cohort was 15%. When stratified by median Ki-67, patients with Ki-67 greater than 15% had lower median vp (0.02 vs 0.10, p = 0.002), and lower median wash-in rate (1.27 vs 4.08 sec-1, p = 0.04) than patients with Ki-67 of 15% or below. Logistic regression analysis demonstrated a statistically significant, moderate positive correlation between ve and time to progression (r = 0.49, p < 0.05). Furthermore, there was a moderate positive correlation between Ktrans and time to progression, which approached, but did not reach, statistical significance (r = 0.48, p = 0.05).CONCLUSIONSThis study demonstrates a potential role for DCE MRI in the preoperative characterization and stratification of meningiomas, laying the foundation for future prospective studies incorporating DCE as a biomarker in meningioma diagnosis and treatment planning.
需要先进的成像生物标志物来改善放射治疗计划和反应评估。T1 加权动态对比增强灌注 MRI（DCE MRI）允许对组织灌注和血脑屏障功能进行定量评估，并已在原发性和继发性脑肿瘤的治疗中进入临床实践。作者试图使用容积分割法回顾性研究接受切除和辅助放射治疗的脑膜瘤的 DCE MRI 参数。
对 2015 年 1 月至 2018 年 12 月间切除的 300 多例脑膜瘤患者进行回顾性分析，确定了 14 例 18 个脑膜瘤患者符合条件，这些患者接受了切除和辅助放疗。如果患者未接受辅助放疗或 DCE MRI，则将其排除在外。获得了患者的人口统计学和临床特征，并与 DCE 灌注指标进行了比较，包括平均血浆容积（vp）、细胞外容积（ve）、容积转移常数（Ktrans）、速率常数（kep）和对比剂进入组织的冲洗速度，这些指标是从感兴趣的增强容积的容积分析中得出的。
患者的平均年龄为 64 岁（49-86 岁），50%的患者（7/14）为女性。肿瘤平均体积为 8.07 cm3（0.21-27.89 cm3）。该队列的中位 Ki-67 为 15%。按 Ki-67 的中位数分层后，Ki-67 大于 15%的患者中位 vp 较低（0.02 比 0.10，p = 0.002），中位冲洗速度较低（1.27 比 4.08 sec-1，p = 0.04）。与 Ki-67 为 15%或以下的患者相比。逻辑回归分析表明，ve 与无进展时间之间存在统计学上显著的中度正相关（r = 0.49，p < 0.05）。此外，Ktrans 与无进展时间之间存在中度正相关，接近但未达到统计学意义（r = 0.48，p = 0.05）。
本研究表明 DCE MRI 在脑膜瘤的术前特征和分层中具有潜在作用，为未来将 DCE 作为脑膜瘤诊断和治疗计划的生物标志物纳入前瞻性研究奠定了基础。
