Szychot Elwira, Youssef Adam, Ganeshan Balaji, Endozo Raymond, Hyare Harpreet, Gains Jenny, Mankad Kshitij, Shankar Ananth
The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK.
Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
J Neuroradiol. 2021 Jun;48(4):243-247. doi: 10.1016/j.neurad.2020.02.005. Epub 2020 Mar 14.
Diffuse midline gliomas (DMG) are aggressive brain tumours, previously known as diffuse intrinsic pontine gliomas (DIPG), with 10% overall survival (OS) at 18 months. Predicting OS will help refine treatment strategy in this patient group. MRI based texture analysis (MRTA) is novel image analysis technique that provides objective information about spatial arrangement of MRI signal intensity (heterogeneity) and has potential to be imaging biomarker.
To investigate MRTA in predicting OS in childhood DMG.
Retrospective study of patients diagnosed with DMG, based on radiological features, treated at our institution 2007-2017. MRIs were acquired at diagnosis and 6 weeks after radiotherapy (54Gy in 30 fractions). MRTA was performed using commercial available TexRAD research software on T2W sequence and Apparent Diffusion Coefficient (ADC) maps encapsulating tumour in the largest single axial plane. MRTA comprised filtration-histogram technique using statistical and histogram metrics for quantification of texture. Kaplan-Meier survival analysis determined association of MRI texture parameters with OS.
In all, 32 children 2-14 years (median 7 years) were included. MRTA was undertaken on T2W (n=32) and ADC (n=22). T2W-MRTA parameters were better at prognosticating than ADC-MRTA. Children with homogenous tumour texture, at medium scale on diagnostic T2W MRI, had worse prognosis (Mean of Positive Pixels (MPP): P=0.005, mean: P=0.009, SD: P=0.011, kurtosis: P=0.037, entropy: P=0.042). Best predictor MPP was able to stratify patients into poor and good prognostic groups with median survival of 7.5 months versus 17.5 months, respectively.
DMG with more homogeneous texture on diagnostic MRI is associated with worse prognosis. Texture parameter MPP is the most predictive marker of OS in childhood DMG.
弥漫性中线胶质瘤（DMG）是侵袭性脑肿瘤，以前称为弥漫性脑桥内在型胶质瘤（DIPG），18个月总生存率（OS）为10%。预测总生存率将有助于优化该患者群体的治疗策略。基于磁共振成像（MRI）的纹理分析（MRTA）是一种新型图像分析技术，可提供有关MRI信号强度空间排列（异质性）的客观信息，有潜力成为成像生物标志物。
研究MRTA在预测儿童DMG总生存率中的作用。
对2007年至2017年在本机构接受治疗、根据放射学特征诊断为DMG的患者进行回顾性研究。在诊断时和放疗（30次分割，共54Gy）后6周进行MRI检查。使用商用TexRAD研究软件在T2加权序列和表观扩散系数（ADC）图上进行MRTA，在最大的单个轴位平面上勾勒出肿瘤。MRTA包括使用统计和直方图指标的滤波-直方图技术来量化纹理。Kaplan-Meier生存分析确定MRI纹理参数与总生存率的关联。
共纳入32名2至14岁（中位年龄7岁）的儿童。对T2加权像（n=32）和ADC图（n=22）进行了MRTA。T2加权像-MRTA参数在预后评估方面比ADC-MRTA更好。在诊断性T2加权MRI上，中等尺度下肿瘤纹理均匀的儿童预后较差（阳性像素均值（MPP）：P=0.005，均值：P=0.009，标准差：P=0.011，峰度：P=0.037，熵：P=0.042）。最佳预测指标MPP能够将患者分为预后差和预后好的两组，中位生存期分别为7.5个月和17.5个月。
诊断性MRI上纹理更均匀的DMG与更差的预后相关。纹理参数MPP是儿童DMG总生存率最具预测性的标志物。
