Zhang Simin, Su Xiaorui, Kemp Graham J, Yang Xibiao, Wan Xinyue, Tan Qiaoyue, Yue Qiang, Gong Qiyong
Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China.
Huaxi Glioma Center, West China Hospital of Sichuan University, Chengdu 610041, China.
J Clin Med. 2022 Jun 27;11(13):3693. doi: 10.3390/jcm11133693.
Background: Multiple lesions are uncommon in brain gliomas, and their pathophysiology is poorly understood. Invasive growth along white matter tracts is an important clinicopathological characteristic of gliomas, and a major factor in a poor therapeutic outcome. Here, we used probabilistic fiber tracking and cluster analysis to investigate the inter-focal connectivity relationships of multiple gliomas, in order to seek inferential evidence of common origin. Methods: MRI scans of 46 patients with multiple gliomas were retrospectively analyzed. Before surgery, all patients underwent multimodal functional MR imaging, including diffusion tensor imaging, enhanced 3D T1-weighted imaging, diffusion-weighted imaging, 1H MR spectroscopy, and dynamic susceptibility contrast perfusion-weighted imaging. Probabilistic fiber tracking was used to quantify white matter connectivity between neoplastic foci. Hierarchical cluster analysis was performed to identify patterns of white matter connection. Results: Cluster analysis reveals two patterns of connectivity, one with smaller, and one with greater, connectivity (2675 ± 1098 versus 30432 ± 22707, p < 0.0001). The two subgroups show significant differences in relative cerebral blood volume (2.31 ± 0.95 versus 1.73 ± 0.48, p = 0.002) and lipid/creatine ratio (0.32 ± 0.22 versus 0.060 ± 0.051, p = 0.006). Conclusion: Two distinct patterns of white matter connection exist in multiple gliomas. Those with lower connectivity tend to have independent origins, and can be termed true multicentric glioma, whereas those with greater connectivity tend to share common origin, and spread along white matter tracts. True multicentric gliomas have higher vascularity and more intratumoral necrosis. These findings may help to develop personalized therapeutic strategies for multiple gliomas.
脑胶质瘤中出现多个病灶的情况并不常见，其病理生理学机制尚不清楚。沿白质纤维束浸润性生长是胶质瘤重要的临床病理特征，也是治疗效果不佳的主要因素。在此，我们运用概率纤维追踪和聚类分析来研究多个胶质瘤病灶间的连接关系，以寻找共同起源的推断证据。方法：对46例患有多个胶质瘤的患者的MRI扫描图像进行回顾性分析。术前，所有患者均接受多模态功能磁共振成像检查，包括扩散张量成像、增强三维T1加权成像、扩散加权成像、氢质子磁共振波谱分析以及动态磁敏感对比灌注加权成像。采用概率纤维追踪技术量化肿瘤病灶间的白质连接情况。进行层次聚类分析以识别白质连接模式。结果：聚类分析揭示了两种连接模式，一种连接性较小，另一种连接性较大（分别为2675±1098与30432±22707，p<0.0001）。这两个亚组在相对脑血容量（分别为2.31±0.95与1.73±0.48，p = 0.002）和脂质/肌酸比值（分别为0.32±0.22与0.
