Department of Diagnostic and Interventional Neuroradiology, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
BMC Med Imaging. 2021 Apr 15;21(1):70. doi: 10.1186/s12880-021-00602-7.
Brain metastases are particularly common in patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), with NSCLC showing a less aggressive clinical course and lower chemo- and radio sensitivity compared to SCLC. Early adequate therapy is highly desirable and depends on a reliable classification of tumor type. The apparent diffusion coefficient is a noninvasive neuroimaging marker with the potential to differentiate between major histological subtypes. Here we determine the sensitivity and specificity of the apparent diffusion coefficient to distinguish between NSCLC and SCLC.
We enrolled all NSCLC and SCLC patients diagnosed between 2008 and 2019 at the University Medical Center Göttingen. Cranial MR scans were visually inspected for brain metastases and the ratio of the apparent diffusion coefficient (ADC) was calculated by dividing the ADC measured within the solid part of a metastasis by a reference ADC extracted from an equivalent region in unaffected tissue on the contralateral hemisphere.
Out of 411 enrolled patients, we detected 129 patients (83 NSCLC, 46 SCLC) with sufficiently large brain metastases with histologically classified lung cancer and no hemorrhage. We analyzed 185 brain metastases, 84 of SCLC and 101 of NSCLC. SCLC brain metastases showed an ADC ratio of 0.68 ± 0.12 SD, and NSCLC brain metastases showed an ADC ratio of 1.47 ± 0.31 SD. Receiver operating curve statistics differentiated brain metastases of NSCLC from SCLC with an area under the curve of 0.99 and a 95% CI of 0.98 to 1, p < 0.001. Youden's J cut-point is 0.97 at a sensitivity of 0.989 and a specificity of 0.988.
In patients with lung cancer and brain metastases with solid tumor parts, ADC ratio enables an ad hoc differentiation of SCLC and NSCLC, easily achieved during routine neuroradiological examination. Non-invasive MR imaging enables an early-individualized management of brain metastases from lung cancer.
The study was registered in the German Clinical Trials Register (DRKS00023016).
脑转移在小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC）患者中尤为常见，与 SCLC 相比，NSCLC 的临床病程侵袭性较低，化疗和放疗敏感性也较低。早期充分的治疗是非常理想的，这取决于对肿瘤类型的可靠分类。表观扩散系数是一种无创神经影像学标志物，具有区分主要组织学亚型的潜力。在这里，我们确定表观扩散系数区分 NSCLC 和 SCLC 的敏感性和特异性。
我们招募了 2008 年至 2019 年期间在哥廷根大学医学中心诊断为 NSCLC 和 SCLC 的所有患者。对颅磁共振扫描进行视觉检查，以检测脑转移，并通过将转移灶实性部分的表观扩散系数（ADC）除以对侧半球无病变组织中提取的参考 ADC 来计算 ADC 比值。
在纳入的 411 名患者中，我们检测到 129 名（83 名 NSCLC，46 名 SCLC）患有具有组织学分类肺癌且无出血的足够大的脑转移。我们分析了 185 个脑转移，84 个 SCLC 和 101 个 NSCLC。SCLC 脑转移的 ADC 比值为 0.68±0.12 SD，NSCLC 脑转移的 ADC 比值为 1.47±0.31 SD。接收者操作曲线统计区分 NSCLC 和 SCLC 的脑转移，曲线下面积为 0.99，95%可信区间为 0.98 至 1，p<0.001。Youden 的 J 切点为 0.97，灵敏度为 0.989，特异性为 0.988。
在具有实性肿瘤部分的肺癌和脑转移患者中，ADC 比值可实现 SCLC 和 NSCLC 的特定区分，在常规神经放射学检查中很容易实现。非侵入性磁共振成像可实现对肺癌脑转移的早期个体化管理。
该研究在德国临床试验注册处（DRKS00023016）注册。
