原发性中枢神经系统淋巴瘤中低血供细胞性肿瘤与治疗抵抗相关：利用生理 MRI 进行肿瘤生境分析。
Hypovascular Cellular Tumor in Primary Central Nervous System Lymphoma is Associated with Treatment Resistance: Tumor Habitat Analysis Using Physiologic MRI.
机构信息
From the Department of Radiology and Research Institute of Radiology (S.Y.J., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
From the Department of Radiology and Research Institute of Radiology (S.Y.J., J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
出版信息
AJNR Am J Neuroradiol. 2022 Jan;43(1):40-47. doi: 10.3174/ajnr.A7351. Epub 2021 Nov 25.
BACKGROUND AND PURPOSE
The microenvironment of lymphomas is known to be highly variable and closely associated with treatment resistance and survival. We tried to develop a physiologic MR imaging-based spatial habitat analysis to identify regions associated with treatment resistance to facilitate the prediction of tumor response after initial chemotherapy in patients with primary central nervous system lymphoma.
MATERIALS AND METHODS
Eighty-one patients with pathologically confirmed primary central nervous system lymphoma were enrolled. Pretreatment physiologic MR imaging was performed, and K-means clustering was used to separate voxels into 3 spatial habitats according to ADC and CBV values. Associations of spatial habitats and clinical and conventional imaging predictors with time to progression were analyzed using Cox proportional hazards modeling. The performance of statistically significant predictors for time to progression was assessed using the concordance probability index.
RESULTS
The 3 spatial habitats of hypervascular cellular tumor, hypovascular cellular tumor, and hypovascular hypocellular tumor were identified. A large hypovascular cellular habitat was most significantly associated with short time to progression (hazard ratio, 2.83; = .017). The presence of an atypical finding (hazard ratio, 4.41; = .016), high performance score (hazard ratio, 5.82; = .04), and high serum lactate dehydrogenase level (hazard ratio, 1.01; = .013) was significantly associated with time to progression. A predictive model constructed using the habitat score and other imaging parameters showed a concordance probability index for prediction of time to progression of 0.70 (95% CI, 0.54-0.87).
CONCLUSIONS
A hypovascular cellular tumor habitat is associated with treatment resistance in primary central nervous system lymphoma, and its assessment may refine prechemotherapy imaging-based response prediction for patients with primary central nervous system lymphoma.
背景与目的
淋巴瘤的微环境具有高度可变性，并且与治疗抵抗和生存密切相关。我们试图开发一种基于生理 MRI 的空间栖息地分析方法，以识别与治疗抵抗相关的区域，从而有助于预测原发性中枢神经系统淋巴瘤患者初始化疗后的肿瘤反应。
材料与方法
共纳入 81 例经病理证实的原发性中枢神经系统淋巴瘤患者。对患者进行了预处理生理 MRI 检查，然后使用 K-means 聚类根据 ADC 和 CBV 值将体素分为 3 个空间栖息地。使用 Cox 比例风险模型分析空间栖息地与临床和常规成像预测因子与进展时间的相关性。使用一致性概率指数评估统计学上显著的进展时间预测因子的性能。
结果
确定了 3 种空间栖息地，即富血管细胞肿瘤、乏血管细胞肿瘤和乏血管低细胞肿瘤。大的乏血管细胞栖息地与较短的进展时间相关性最强（风险比，2.83；=0.017）。存在不典型表现（风险比，4.41；=0.016）、高表现评分（风险比，5.82；=0.04）和高血清乳酸脱氢酶水平（风险比，1.01；=0.013）与进展时间显著相关。使用栖息地评分和其他成像参数构建的预测模型预测进展时间的一致性概率指数为 0.70（95%CI，0.54-0.87）。
结论
原发性中枢神经系统淋巴瘤中乏血管细胞肿瘤栖息地与治疗抵抗相关，其评估可能会细化原发性中枢神经系统淋巴瘤患者化疗前基于影像学的反应预测。
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