Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Abdom Radiol (NY). 2021 Jul;46(7):3317-3325. doi: 10.1007/s00261-021-03032-9. Epub 2021 Mar 12.
To assess the value of diffusion-weighted MRI (DW-MRI) in the non-invasive prediction of blastemal remnant after neoadjuvant chemotherapy in nephroblastoma.
This IRB-approved study included 32 pediatric patients with 35 tumors who underwent DW-MRI prior and after completion of neoadjuvant chemotherapy and subsequent surgical resection. Two blinded radiologists volumetrically assessed each tumor on pre- and post-neoadjuvant images and the parameters mean ADC, median ADC, 12.5th/25th/75th ADC percentile, skewness, and kurtosis were calculated. Blastemal remnant was determined per the pathology report. Associations between imaging features and blastemal remnant quartiles were examined using the Kruskal-Wallis test and adjusted for false discovery rate.
Inter-reader agreement was high for mean ADC, skewness, kurtosis, and volume (ICC: 0.76-0.998). Pre-therapeutic histogram parameters skewness and kurtosis were found to be higher in patients with a higher amount of blastemal remnant for reader 1 (overall p = 0.035) and for kurtosis in reader 2 (overall p = 0.032) with skewness not reaching the level of statistical significance (overall p = 0.055). Higher tumor volume on pre-treatment imaging was associated with a higher amount of blastemal remnant after therapy (overall p = 0.032 for both readers).
Pre-treatment skewness and kurtosis of ADC histogram analysis were significantly associated with a larger fraction of a blastemal remnant after neoadjuvant chemotherapy. These findings could be incorporated into a more personalized chemotherapeutic regime in these patients and offer prognostic information at the time of initial diagnosis.
评估弥散加权磁共振成像（DW-MRI）在肾母细胞瘤新辅助化疗后预测胚细胞瘤残留中的价值。
本研究经机构审查委员会批准，纳入 32 名接受新辅助化疗前后 DW-MRI 检查的儿童患者，共 35 个肿瘤，随后进行手术切除。两名盲法阅片医生分别对新辅助治疗前后的肿瘤进行容积评估，并计算平均 ADC 值、中位数 ADC 值、12.5%/25%/75% ADC 百分位数、偏度和峰度等参数。根据病理报告确定胚细胞瘤残留情况。使用 Kruskal-Wallis 检验评估影像学特征与胚细胞瘤残留四分位数之间的相关性，并进行假发现率校正。
平均 ADC 值、偏度、峰度和体积的观察者间一致性较高（ICC：0.76-0.998）。对于读者 1，治疗前直方图参数偏度和峰度在胚细胞瘤残留较多的患者中较高（总体 p=0.035），对于读者 2，峰度在较高的胚细胞瘤残留患者中较高（总体 p=0.032），但偏度未达到统计学显著水平（总体 p=0.055）。治疗前肿瘤体积越大，治疗后胚细胞瘤残留量越高（两位读者的总体 p 值均为 0.032）。
治疗前 ADC 直方图分析的偏度和峰度与新辅助化疗后胚细胞瘤残留量显著相关。这些发现可以纳入这些患者的更个体化化疗方案中，并在初始诊断时提供预后信息。
