Kurokawa Ryo, Umemura Yoshie, Capizzano Aristides, Kurokawa Mariko, Baba Akira, Holmes Adam, Kim John, Ota Yoshiaki, Srinivasan Ashok, Moritani Toshio
Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
J Neuroimaging. 2022 May;32(3):511-520. doi: 10.1111/jon.12962. Epub 2022 Jan 7.
The utility of perfusion MRI in distinguishing between pilocytic astrocytoma (PA) and medulloblastoma (MB) is unclear. This study aimed to evaluate the diagnostic and prognostic performance of dynamic susceptibility contrast (DSC)-MRI parameters and apparent diffusion coefficient (ADC) values between PA and MB.
Between January 2012 and August 2021, 49 (median, 7 years [range, 1-28 years]; 28 females) and 35 (median, 8 years [1-24 years]; 12 females) patients with pathologically confirmed PA and MB, respectively, were included. The normalized relative cerebral blood volume and flow (nrCBV and nrCBF) and mean and minimal normalized ADC (nADCmean and nADCmin) values were calculated using volume-of-interest analyses. Diagnostic performance and Pearson's correlation with progression-free survival were also evaluated.
The MB group showed a significantly higher nrCBV and nrCBF (nrCBV: 1.69 [0.93-4.23] vs. 0.95 [range, 0.37-2.28], p = .0032; nrCBF: 1.62 [0.93-3.16] vs. 1.07 [0.46-2.26], p = .0084) and significantly lower nADCmean and nADCmin (nADCmean: 0.97 [0.70-1.68] vs. 2.21 [1.44-2.80], p < .001; nADCmin: 0.50 [0.19-0.89] vs. 1.42 [0.89-2.20], p < .001) than the PA group. All parameters exhibited good diagnostic ability (accuracy >0.80) with nADCmin achieving the highest score (accuracy = 1). A moderate correlation was found between nADCmean and progression-free survival for MB (r = 0.44, p = .0084).
DSC-MRI parameters and ADC values were useful for distinguishing between PA and MB. A lower ADC indicated an unfavorable MB prognosis, but the DSC-MRI parameters did not correlate with progression-free survival in either group.
灌注磁共振成像（MRI）在鉴别毛细胞型星形细胞瘤（PA）和髓母细胞瘤（MB）中的作用尚不清楚。本研究旨在评估动态磁敏感对比（DSC）-MRI参数及表观扩散系数（ADC）值在PA和MB之间的诊断及预后价值。
纳入2012年1月至2021年8月期间分别经病理证实为PA和MB的患者，PA组49例（中位年龄7岁[范围1 - 28岁]；女性28例），MB组35例（中位年龄8岁[1 - 24岁]；女性12例）。采用感兴趣区分析计算标准化相对脑血容量和血流（nrCBV和nrCBF）以及平均和最小标准化ADC（nADCmean和nADCmin）值。还评估了诊断性能以及与无进展生存期的Pearson相关性。
MB组的nrCBV和nrCBF显著高于PA组（nrCBV：1.69[0.93 - 4.23] vs. 0.95[范围0.37 - 2.28]，p = 0.0032；nrCBF：1.62[0.93 - 3.16] vs. 1.07[0.46 - 2.26]，p = 0.0084），nADCmean和nADCmin显著低于PA组（nADCmean：0.97[0.70 - 1.68] vs. 2.21[1.44 - 2.80]，p < 0.001；nADCmin：0.50[0.19 - 0.89] vs. 1.42[0.89 - 2.20]，p < 0.001）。所有参数均具有良好的诊断能力（准确率>0.80），其中nADCmin得分最高（准确率 = 1）。MB组中nADCmean与无进展生存期之间存在中度相关性（r = 0.44，p = 0.0084）。
DSC-MRI参数及ADC值有助于鉴别PA和MB。较低的ADC提示MB预后不良，但DSC-MRI参数与两组的无进展生存期均无相关性。
