基于胶质母细胞瘤患者非增强、T2 高信号强度病变的动态对比增强 MRI 和动态磁敏感对比增强 MRI 参数的预后预测。

Prognostic Prediction Based on Dynamic Contrast-Enhanced MRI and Dynamic Susceptibility Contrast-Enhanced MRI Parameters from Non-Enhancing, T2-High-Signal-Intensity Lesions in Patients with Glioblastoma.

机构信息

Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.

Department of Radiology, Seoul National University Hospital, Seoul, Korea.

出版信息

Korean J Radiol. 2021 Aug;22(8):1369-1378. doi: 10.3348/kjr.2020.1272. Epub 2021 May 4.

OBJECTIVE

Few attempts have been made to investigate the prognostic value of dynamic contrast-enhanced (DCE) MRI or dynamic susceptibility contrast (DSC) MRI of non-enhancing, T2-high-signal-intensity (T2-HSI) lesions of glioblastoma multiforme (GBM) in newly diagnosed patients. This study aimed to investigate the prognostic values of DCE MRI and DSC MRI parameters from non-enhancing, T2-HSI lesions of GBM.

MATERIALS AND METHODS

A total of 76 patients with GBM who underwent preoperative DCE MRI and DSC MRI and standard treatment were retrospectively included. Six months after surgery, the patients were categorized into early progression (n = 15) and non-early progression (n = 61) groups. We extracted and analyzed the permeability and perfusion parameters of both modalities for the non-enhancing, T2-HSI lesions of the tumors. The optimal percentiles of the respective parameters obtained from cumulative histograms were determined using receiver operating characteristic (ROC) curve and univariable Cox regression analyses. The results were compared using multivariable Cox proportional hazards regression analysis of progression-free survival.

RESULTS

The 95th percentile value (PV) of Ktrans, mean Ktrans, and median Ve were significant predictors of early progression as identified by the ROC curve analysis (area under the ROC curve [AUC] = 0.704, = 0.005; AUC = 0.684, = 0.021; and AUC = 0.670, = 0.0325, respectively). Univariable Cox regression analysis of the above three parametric values showed that the 95th PV of Ktrans and the mean Ktrans were significant predictors of early progression (hazard ratio [HR] = 1.06, = 0.009; HR = 1.25, = 0.017, respectively). Multivariable Cox regression analysis, which also incorporated clinical parameters, revealed that the 95th PV of Ktrans was the sole significant independent predictor of early progression (HR = 1.062, < 0.009).

CONCLUSION

The 95th PV of Ktrans from the non-enhancing, T2-HSI lesions of GBM is a potential prognostic marker for disease progression.

目的

目前鲜少有研究调查动态对比增强（DCE）MRI 或动态磁敏感对比（DSC）MRI 对新诊断的多形性胶质母细胞瘤（GBM）中不增强、T2 高信号强度（T2-HSI）病变的预后价值。本研究旨在调查 DCE MRI 和 DSC MRI 来自 GBM 中不增强、T2-HSI 病变的参数的预后价值。

材料和方法

回顾性纳入 76 例接受术前 DCE MRI 和 DSC MRI 及标准治疗的 GBM 患者。术后 6 个月，患者分为早期进展（n = 15）和非早期进展（n = 61）组。我们提取并分析了肿瘤不增强、T2-HSI 病变的两种方式的渗透性和灌注参数。通过接受者操作特征（ROC）曲线和单变量 Cox 回归分析确定各自参数累积直方图的最佳百分位数。通过无进展生存的多变量 Cox 比例风险回归分析比较结果。

结果

ROC 曲线分析发现，Ktrans 的 95%百分位数（PV）、平均 Ktrans 和中位数 Ve 是早期进展的显著预测指标（ROC 曲线下面积 [AUC] = 0.704， = 0.005；AUC = 0.684， = 0.021；AUC = 0.670， = 0.0325）。对上述三个参数值的单变量 Cox 回归分析显示，Ktrans 的 95%PV 和平均 Ktrans 是早期进展的显著预测指标（风险比 [HR] = 1.06， = 0.009；HR = 1.25， = 0.017）。纳入临床参数的多变量 Cox 回归分析显示，Ktrans 的 95%PV 是早期进展的唯一显著独立预测指标（HR = 1.062， < 0.009）。