Department of Radiology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China.
Department of Radiotherapy, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, People's Republic of China.
Eur Radiol. 2023 Jul;33(7):4812-4821. doi: 10.1007/s00330-023-09437-y. Epub 2023 Feb 3.
To investigate the correlation of conventional MRI, DCE-MRI and clinical features with pain response after stereotactic body radiotherapy (SBRT) in patients with spinal metastases and establish a pain response prediction model.
Patients with spinal metastases who received SBRT in our hospital from July 2018 to April 2022 consecutively were enrolled. All patients underwent conventional MRI and DCE-MRI before treatment. Pain was assessed before treatment and in the third month after treatment, and the patients were divided into pain-response and no-pain-response groups. A multivariate logistic regression model was constructed to obtain the odds ratio and 95% confidence interval (CI) for each variable. C-index was used to evaluate the model's discrimination performance.
Overall, 112 independent spinal lesions in 89 patients were included. There were 73 (65.2%) and 39 (34.8%) lesions in the pain-response and no-pain-response groups, respectively. Multivariate analysis showed that the number of treated lesions, pretreatment pain score, Karnofsky performance status score, Bilsky grade, and the DCE-MRI quantitative parameter K were independent predictors of post-SBRT pain response in patients with spinal metastases. The discrimination performance of the prediction model was good; the C index was 0.806 (95% CI: 0.721-0.891), and the corrected C-index was 0.754.
Some imaging and clinical features correlated with post-SBRT pain response in patients with spinal metastases. The model based on these characteristics has a good predictive value and can provide valuable information for clinical decision-making.
• SBRT can accurately irradiate spinal metastases with ablative doses. • Predicting the post-SBRT pain response has important clinical implications. • The prediction models established based on clinical and MRI features have good performance.
探讨常规 MRI、DCE-MRI 与临床特征与脊柱转移瘤立体定向体部放疗（SBRT）后疼痛反应的相关性，并建立疼痛反应预测模型。
连续纳入 2018 年 7 月至 2022 年 4 月在我院接受 SBRT 的脊柱转移瘤患者。所有患者治疗前均行常规 MRI 和 DCE-MRI 检查。治疗前及治疗后 3 个月评估疼痛，并将患者分为疼痛反应组和无疼痛反应组。采用多因素逻辑回归模型获取各变量的比值比和 95%置信区间（CI）。采用 C 指数评估模型的判别性能。
共纳入 89 例患者的 112 个独立脊柱病灶，疼痛反应组和无疼痛反应组分别有 73（65.2%）和 39（34.8%）个病灶。多因素分析显示，治疗病灶数、治疗前疼痛评分、卡氏功能状态评分、Bilsky 分级和 DCE-MRI 定量参数 K 是脊柱转移瘤患者 SBRT 后疼痛反应的独立预测因子。预测模型的判别性能较好；C 指数为 0.806（95%CI：0.721-0.891），校正 C 指数为 0.754。
部分影像学和临床特征与脊柱转移瘤 SBRT 后疼痛反应相关，基于这些特征的模型具有良好的预测价值，可为临床决策提供有价值的信息。
SBRT 能够以根治性剂量精确照射脊柱转移瘤。
预测 SBRT 后疼痛反应具有重要的临床意义。
基于临床和 MRI 特征建立的预测模型具有良好的性能。
