预测骨肉瘤患者新辅助化疗的不良反应者：3T 标准 MRI 联合容积分析的弥散加权 MRI 的附加价值。

Prediction of Poor Responders to Neoadjuvant Chemotherapy in Patients with Osteosarcoma: Additive Value of Diffusion-Weighted MRI including Volumetric Analysis to Standard MRI at 3T.

机构信息

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea.

Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea.

出版信息

PLoS One. 2020 Mar 10;15(3):e0229983. doi: 10.1371/journal.pone.0229983. eCollection 2020.

OBJECTIVE

To evaluate the added value of diffusion weighted image (DWI) including volumetric analysis to standard magnetic resonance imaging (MRI) for predicting poor responders to neoadjuvant chemotherapy in patients with osteosarcoma at 3-Tesla.

METHODS

3-Tesla Standard MRI and DWI in 17 patients were reviewed by two independent readers. Standard MRI was reviewed using a five-level-confidence score. Two-dimensional (2D) apparent diffusion coefficient (ADC)mean and 2D ADCminimum were measured from a single-section region of interest. An ADC histogram derived from whole-tumor volume was generated including 3D ADCmean, 3D ADCskewness, and 3D ADCkurtosis. The Mann-Whitney-U test, receiver operating characteristic curve with area under the curve (AUC) analysis, and multivariate logistic regression analysis were performed.

RESULTS

There were 13 poor responders and 4 good responders. Statistical differences were found in posttreatment and percent change of both 2D ADCmean and 2D ADCminimum, posttreatment 3D ADCmean, and posttreatment 3D ADCskewness between two groups. The best predictors of poor responders were posttreatment 2D ADCmean and posttreatment 3D ADCskewness. Sensitivity and specificity of the 1st model (standard MRI alone), 2nd model (standard MRI+posttreatment 2D ADCmean), and 3rd model (standard MRI+posttreatment 2D ADCmean+posttreatment 3D ADCskewness) were 85% and 25%, 85% and 75%, and 85% and 100% for reader 1 and 77% and 25%, 77% and 50%, and 85% and 100% for reader 2, respectively. The AUC of the 1st, 2nd, and 3rd models were 0.548, 0.798, and 0.923 for reader 1 and 0.510, 0.635, and 0.923 for reader 2, respectively.

CONCLUSION

The addition of DWI including volumetric analysis to standard MRI improves the diagnostic accuracy for predicting poor responders to neoadjuvant chemotherapy in patients with osteosarcoma at 3-Tesla.

目的

在 3.0T 磁共振成像（MRI）中，评估扩散加权成像（DWI）联合体素分析对骨肉瘤患者新辅助化疗后无应答者的预测价值。

方法

对 17 例患者的 3.0T 标准 MRI 和 DWI 进行了回顾性分析。采用 5 级置信评分对标准 MRI 进行了评估。从单节感兴趣区测量二维（2D）表观扩散系数（ADC）均值和 2D ADC 最小值。生成全肿瘤体积 ADC 直方图，包括 3D ADC 均值、3D ADC 偏度和 3D ADC 峰度。采用 Mann-Whitney-U 检验、曲线下面积（AUC）分析的受试者工作特征曲线和多变量逻辑回归分析。

结果

有 13 例为化疗无应答者，4 例为化疗有应答者。两组间治疗后及治疗后变化的 2D ADC 均值和 2D ADC 最小值、治疗后 3D ADC 均值、治疗后 3D ADC 偏度均存在统计学差异。治疗后 2D ADC 均值和治疗后 3D ADC 偏度是化疗无应答者的最佳预测指标。读者 1 的第 1 模型（单纯标准 MRI）、第 2 模型（标准 MRI+治疗后 2D ADC 均值）和第 3 模型（标准 MRI+治疗后 2D ADC 均值+治疗后 3D ADC 偏度）的灵敏度和特异度分别为 85%和 25%、85%和 75%，以及 85%和 100%；读者 2 的灵敏度和特异度分别为 77%和 25%、77%和 50%，以及 85%和 100%。第 1、2、3 模型的 AUC 为读者 1 的 0.548、0.798 和 0.923，读者 2 的 0.510、0.635 和 0.923。