基于弥散张量成像的中心性弥散降低征象鉴别放射性脑损伤与肿瘤进展的价值：一项验证性研究
Centrally Reduced Diffusion Sign for Differentiation between Treatment-Related Lesions and Glioma Progression: A Validation Study.
机构信息
From the Department of Medical Imaging (P.A.-L.), University Health Network, Toronto, Ontario, Canada.
Department of Radiology and Biomedical Imaging (J.C., J.M.L., T.J.Y., T.L.L., J.E.V.-M.).
出版信息
AJNR Am J Neuroradiol. 2020 Nov;41(11):2049-2054. doi: 10.3174/ajnr.A6843. Epub 2020 Oct 15.
BACKGROUND AND PURPOSE
Differentiating between treatment-related lesions and tumor progression remains one of the greatest dilemmas in neuro-oncology. Diffusion MR imaging characteristics may provide useful information to help make this distinction. The aim of the study was to assess the diagnostic accuracy of the centrally reduced diffusion sign for differentiation of treatment-related lesions and true tumor progression in patients with suspected glioma recurrence.
MATERIALS AND METHODS
The images of 231 patients who underwent an operation for suspected glioma recurrence were reviewed. Patients with susceptibility artifacts or without central necrosis were excluded. The final diagnosis was established according to histopathology reports. Two neuroradiologists classified the diffusion patterns on preoperative MR imaging as the following: 1) reduced diffusion in the solid component only, 2) reduced diffusion mainly in the solid component, 3) no reduced diffusion, 4) reduced diffusion mainly in the central necrosis, and 5) reduced diffusion in the central necrosis only. Diagnostic accuracy metrics and the area under the receiver operating characteristic curve were estimated for the diffusion patterns.
RESULTS
One hundred three patients were included (22 with treatment-related lesions and 81 with tumor progression). The diagnostic accuracy results for the centrally reduced diffusion pattern as a predictor of treatment-related lesions ("mainly central" and "exclusively central" patterns versus all other patterns) were as follows: 64% sensitivity (95% CI, 41%-83%), 84% specificity (95% CI, 74%-91%), 52% positive predictive value (95% CI, 37%-66%), and 89% negative predictive value (95% CI, 83%-94%).
CONCLUSIONS
The centrally reduced diffusion sign is associated with the presence of treatment effect. The probability of a histologic diagnosis of a treatment-related lesion is low (11%) in the absence of centrally reduced diffusion.
背景与目的
在神经肿瘤学中，区分治疗相关病变与肿瘤进展仍然是最大的难题之一。弥散磁共振成像特征可能提供有用的信息，有助于做出这种区分。本研究旨在评估中央弥散受限征在区分疑似胶质瘤复发患者的治疗相关病变与真正肿瘤进展方面的诊断准确性。
材料与方法
对 231 例接受疑似胶质瘤复发手术的患者的图像进行了回顾性分析。排除了有磁化传递失相位伪影或无中央坏死的患者。最终诊断根据组织病理学报告确定。两位神经放射科医生对术前磁共振成像的弥散模式进行了分类：1）仅在实体部分有弥散受限，2）主要在实体部分有弥散受限，3）无弥散受限，4）主要在中央坏死区有弥散受限，5）仅在中央坏死区有弥散受限。对弥散模式的诊断准确性指标和受试者工作特征曲线下面积进行了评估。
结果
共纳入 103 例患者（22 例为治疗相关病变，81 例为肿瘤进展）。作为治疗相关病变预测因子的中央弥散受限模式（“主要中央”和“完全中央”模式与所有其他模式相比）的诊断准确性结果如下：64%的敏感性（95%CI，41%-83%），84%的特异性（95%CI，74%-91%），52%的阳性预测值（95%CI，37%-66%）和 89%的阴性预测值（95%CI，83%-94%）。
结论
中央弥散受限征与治疗效果有关。在不存在中央弥散受限的情况下，组织学诊断为治疗相关病变的可能性较低（11%）。
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