From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
From the Department of Radiology and Research Institute of Radiology (M.K., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
AJNR Am J Neuroradiol. 2021 Apr;42(4):663-670. doi: 10.3174/ajnr.A6984. Epub 2021 Feb 4.
Currently available perfusion parameters are limited in differentiating early tumor progression and pseudoprogression with no insight about vessel size and type. We aimed to investigate differences in vessel size and type between early tumor progression and pseudoprogression in posttreatment glioblastoma and to demonstrate diagnostic performance using vessel architectural imaging.
Fifty-eight patients with enlarging contrast-enhancing masses in posttreatment glioblastomas underwent simultaneous gradient recalled-echo and spin-echo dynamic susceptibility contrast imaging. Relative CBV and vessel architectural imaging parameters, including the relative vessel size index, peak shift between gradient recalled echo and spin-echo bolus signal peaks, and arterial dominance scores using spatial dominance of arterial/venous vessel type, were calculated and compared between the 2 conditions. The area under the curve and cross-validation were performed to compare the diagnostic performance of the relative CBV, vessel architectural imaging parameters, and their combinations.
There were 41 patients with early tumor progression and 17 patients with pseudoprogression. Relative to pseudoprogression, early tumor progression showed a lower peak shift (-0.02 versus 0.33, = .02) and a lower arterial dominance score (1.46 versus 2.11, = .001), indicating venous dominance. Patients with early tumor progression had higher relative CBV (1.88 versus 1.38, = .02) and a tendency toward a larger relative vessel size index (99.67 versus 83.17, = .15) than those with pseudoprogression. Combining arterial dominance scores and relative CBV showed significantly higher diagnostic performance (area under the curve = 0.82; 95% CI, 0.70-0.94; = .02) than relative CBV alone (area under the curve = 0.64; 95% CI, 0.49-0.79) in distinguishing early tumor progression from pseudoprogression.
Vessel architectural imaging significantly improved the diagnostic performance of relative CBV by demonstrating venous dominance and a tendency toward larger vessel size in early tumor progression.
目前可用的灌注参数在区分早期肿瘤进展和假性进展方面存在局限性，无法了解血管大小和类型。我们旨在研究治疗后胶质母细胞瘤中早期肿瘤进展和假性进展之间血管大小和类型的差异，并使用血管结构成像来证明其诊断性能。
58 例治疗后对比增强肿块增大的患者接受了梯度回波和自旋回波动态对比磁共振成像。计算并比较了 2 种情况下相对 CBV 和血管结构成像参数，包括相对血管大小指数、梯度回波和自旋回波对比剂团注信号峰值之间的峰值偏移，以及使用动脉/静脉血管类型空间优势的动脉优势评分。绘制曲线下面积并进行交叉验证，比较相对 CBV、血管结构成像参数及其组合的诊断性能。
41 例为早期肿瘤进展，17 例为假性进展。与假性进展相比，早期肿瘤进展的峰值偏移较低（-0.02 对 0.33，P=0.02），动脉优势评分较低（1.46 对 2.11，P=0.001），提示静脉优势。早期肿瘤进展患者的相对 CBV 较高（1.88 对 1.38，P=0.02），相对血管大小指数有增高趋势（99.67 对 83.17，P=0.15），高于假性进展患者。联合动脉优势评分和相对 CBV 显示，在鉴别早期肿瘤进展与假性进展方面，诊断性能显著高于相对 CBV （曲线下面积=0.82；95%CI，0.70-0.94；P=0.02）。
血管结构成像通过显示早期肿瘤进展中的静脉优势和血管大小增大的趋势，显著提高了相对 CBV 的诊断性能。
