利用术前扩散加权成像获得的表观扩散系数图预测颅内脑膜瘤的一致性
Predicting the consistency of intracranial meningiomas using apparent diffusion coefficient maps derived from preoperative diffusion-weighted imaging.
作者信息
Miyoshi Kenya, Wada Tsukasa, Uwano Ikuko, Sasaki Makoto, Saura Hiroaki, Fujiwara Shunrou, Takahashi Fumiaki, Tsushima Eiki, Ogasawara Kuniaki
机构信息
1Department of Neurosurgery and.
2Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, and.
出版信息
J Neurosurg. 2020 Nov 13;135(3):969-976. doi: 10.3171/2020.6.JNS20740. Print 2021 Sep 1.
OBJECTIVE
The consistency of meningiomas is a critical factor affecting the difficulty of resection, operative complications, and operative time. The apparent diffusion coefficient (ADC) is derived from diffusion-weighted imaging (DWI) and is calculated using two optimized b values. While the results of comparisons between the standard ADC and the consistency of meningiomas vary, the shifted ADC has been reported to be strongly correlated with liver stiffness. The purpose of the present prospective cohort study was to determine whether preoperative standard and shifted ADC maps predict the consistency of intracranial meningiomas.
METHODS
Standard (b values 0 and 1000 sec/mm2) and shifted (b values 200 and 1500 sec/mm2) ADC maps were calculated using preoperative DWI in patients undergoing resection of intracranial meningiomas. Regions of interest (ROIs) were placed within the tumor on standard and shifted ADC maps and registered on the navigation system. Tumor tissue located at the registered ROI was resected through craniotomy, and its stiffness was measured using a durometer. The cutoff point lying closest to the upper left corner of a receiver operating characteristic (ROC) curve was determined for the detection of tumor stiffness such that an ultrasonic aspirator or scissors was always required for resection. Each tumor tissue sample with stiffness greater than or equal to or less than this cutoff point was defined as hard or soft tumor, respectively.
RESULTS
For 76 ROIs obtained from 25 patients studied, significant negative correlations were observed between stiffness and the standard ADC (ρ = -0.465, p < 0.01) and the shifted ADC (ρ = -0.490, p < 0.01). The area under the ROC curve for detecting hard tumor (stiffness ≥ 20.8 kPa) did not differ between the standard ADC (0.820) and the shifted ADC (0.847) (p = 0.39). The positive predictive value (PPV) for the combination of a low standard ADC and a low shifted ADC for detecting hard tumor was 89%. The PPV for the combination of a high standard ADC and a high shifted ADC for detecting soft tumor (stiffness < 20.8 kPa) was 81%.
CONCLUSIONS
A combination of standard and shifted ADC maps derived from preoperative DWI can be used to predict the consistency of intracranial meningiomas.
目的
脑膜瘤的质地是影响切除难度、手术并发症及手术时间的关键因素。表观扩散系数（ADC）由扩散加权成像（DWI）得出，通过两个优化的b值计算。虽然标准ADC与脑膜瘤质地的比较结果各异，但据报道偏移ADC与肝脏硬度密切相关。本前瞻性队列研究的目的是确定术前标准及偏移ADC图能否预测颅内脑膜瘤的质地。
方法
对接受颅内脑膜瘤切除术的患者，利用术前DWI计算标准（b值为0和1000秒/平方毫米）及偏移（b值为200和1500秒/平方毫米）ADC图。在标准及偏移ADC图上的肿瘤区域放置感兴趣区（ROI），并在导航系统上进行配准。通过开颅手术切除位于配准ROI处的肿瘤组织，并用硬度计测量其硬度。确定最接近受试者工作特征（ROC）曲线左上角的截断点，用于检测肿瘤硬度，以便确定切除时是否始终需要超声吸引器或剪刀。硬度大于或等于或小于该截断点的每个肿瘤组织样本分别定义为硬肿瘤或软肿瘤。
结果
对25例患者的76个ROI进行研究，发现硬度与标准ADC（ρ = -0.465，p < 0.01）及偏移ADC（ρ = -0.490，p < 0.01）之间存在显著负相关。检测硬肿瘤（硬度≥20.8 kPa）时，标准ADC（0.820）和偏移ADC（0.847）的ROC曲线下面积无差异（p = 0.39）。低标准ADC和低偏移ADC联合检测硬肿瘤的阳性预测值（PPV）为89%。高标准ADC和高偏移ADC联合检测软肿瘤（硬度<20.8 kPa）的PPV为81%。
结论
术前DWI得出的标准及偏移ADC图联合应用可用于预测颅内脑膜瘤的质地。
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