Institute of Neuroradiology, Goethe University Hospital, Frankfurt am Main, Germany.
German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
PLoS One. 2023 Feb 1;18(2):e0274400. doi: 10.1371/journal.pone.0274400. eCollection 2023.
When evaluating MRIs for glioblastoma progression, previous scans are usually included into the review. Nowadays dynamic susceptibility contrast (DSC)-perfusion is an essential component in MR-diagnostics of gliomas, since the extent of hyperperfusion upon first diagnosis correlates with gene expression and survival. We aimed to investigate if this initial perfusion signature also characterizes the glioblastoma at time of progression. If so, DSC-perfusion data from the initial diagnosis could be of diagnostic benefit in follow-up assessments.
We retrospectively identified 65 patients with isocitrate dehydrogenase wildtype glioblastoma who had received technically identical DSC-perfusion measurements at initial diagnosis and at time of first progression. We determined maximum relative cerebral blood volume values (rCBVmax) by standardized re-evaluation of the data including leakage correction. In addition, the corresponding tissue samples from 24 patients were examined histologically for the maximum vessel density within the tumor. Differences (paired t-test/ Wilcoxon matched pairs test) and correlations (Spearman) between the measurements at both timepoints were calculated.
The rCBVmax was consistently lower at time of progression compared to rCBVmax at time of first diagnosis (p < .001). There was no correlation between the rCBVmax values at both timepoints (r = .12). These findings were reflected in the histological examination, with a lower vessel density in progressive glioblastoma (p = .01) and no correlation between the two timepoints (r = -.07).
Our results suggest that the extent of hyperperfusion in glioblastoma at first diagnosis is not a sustaining tumor characteristic. Hence, the rCBVmax at initial diagnosis should be disregarded when reviewing MRIs for glioblastoma progression.
在评估胶质母细胞瘤的进展时，通常会将之前的扫描纳入评估范围。如今，动态磁敏感对比（DSC）灌注是胶质瘤磁共振诊断的重要组成部分，因为首次诊断时的过度灌注程度与基因表达和生存率相关。我们旨在研究这种初始灌注特征是否也能描述进展时的胶质母细胞瘤。如果是这样，初始诊断时的 DSC 灌注数据在随访评估中可能具有诊断价值。
我们回顾性地确定了 65 名异柠檬酸脱氢酶野生型胶质母细胞瘤患者，他们在初次诊断和首次进展时接受了技术上相同的 DSC 灌注测量。我们通过对数据进行标准化重新评估，包括漏出校正，确定最大相对脑血容量值（rCBVmax）。此外，对 24 名患者的相应组织样本进行了组织学检查，以确定肿瘤内的最大血管密度。计算了两个时间点之间测量值的差异（配对 t 检验/ Wilcoxon 匹配对检验）和相关性（Spearman）。
与初次诊断时的 rCBVmax 相比，进展时的 rCBVmax 始终较低（p<0.001）。两个时间点的 rCBVmax 值之间没有相关性（r=0.12）。这些发现反映在组织学检查中，进展性胶质母细胞瘤的血管密度较低（p=0.01），且两个时间点之间没有相关性（r=-0.07）。
我们的结果表明，初次诊断时胶质母细胞瘤的过度灌注程度不是维持肿瘤的特征。因此，在复查胶质母细胞瘤进展的 MRI 时，应忽略初始诊断时的 rCBVmax 值。
