Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
World Neurosurg. 2021 May;149:e469-e480. doi: 10.1016/j.wneu.2021.02.002. Epub 2021 Feb 7.
Pulsed arterial spin-labeling, diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) are useful for predicting glioma survival. We performed a comparative review of multiple parameters obtained using these pulse sequences on 3-Tesla magnetic resonance imaging (MRI) including the molecular status and Ki-67 labeling index in newly diagnosed supratentorial glioblastomas.
A total of 35 patients with glioblastomas underwent pulsed arterial spin-labeling, DTI, and MRS studies using 3-Tesla MRI preoperatively. The isocitrate dehydrogenase (IDH) mutation status, methylguanine-DNA methyltransferase methylation status, and Ki-67 labeling index were calculated from the tumor specimen. Cutoff values were identified by analyzing a receiver operating characteristic curve, and the multivariate survival statistical technique was performed to determine the significant and independent parameters for predicting overall survival.
The multivariate Cox analysis showed that the maximum/mean relative cerebral blood flow (rCBF) ratio and the Ki-67 labeling index were significant and independent predictive parameters with a cutoff value of 1.589 for the maximum rCBF ratio, 1.286 for the mean rCBF ratio, and 19% for the Ki-67 labeling index and hazard ratios of 6.132 and 5.119, respectively. The Kaplan-Meier survival curves showed that patients with higher rCBF ratios and Ki-67 labeling indices had a shorter overall survival than others, with median overall survival durations of 479 (95% CI, 370-559) and 1243 (95% CI, 666-NA) days, respectively (P = 0.000167).
Our findings indicate that the preoperative rCBF ratio and Ki-67 labeling index are useful parameters for predicting the overall survival of cerebral glioblastomas.
脉冲动脉自旋标记、弥散张量成像（DTI）和磁共振波谱（MRS）可用于预测胶质母细胞瘤的生存。我们对新诊断的幕上胶质母细胞瘤患者在 3T 磁共振成像（MRI）上使用这些脉冲序列获得的多个参数进行了比较分析，包括分子状态和 Ki-67 标记指数。
共 35 例胶质母细胞瘤患者在术前接受了脉冲动脉自旋标记、DTI 和 MRS 研究。从肿瘤标本中计算异柠檬酸脱氢酶（IDH）突变状态、甲基鸟嘌呤-DNA 甲基转移酶甲基化状态和 Ki-67 标记指数。通过分析接受者操作特征曲线确定截断值，并使用多变量生存统计技术确定用于预测总生存期的显著和独立参数。
多变量 Cox 分析显示，最大/平均相对脑血流量（rCBF）比值和 Ki-67 标记指数是显著和独立的预测参数，最大 rCBF 比值的截断值为 1.589，平均 rCBF 比值的截断值为 1.286，Ki-67 标记指数的截断值为 19%，风险比分别为 6.132 和 5.119。Kaplan-Meier 生存曲线显示，rCBF 比值和 Ki-67 标记指数较高的患者总生存期较短，中位总生存期分别为 479（95%CI，370-559）和 1243（95%CI，666-NA）天（P=0.000167）。
我们的研究结果表明，术前 rCBF 比值和 Ki-67 标记指数是预测脑胶质母细胞瘤总生存期的有用参数。
