Bartlett Seamus, Nagaraja Tavarekere N, Griffith Brent, Farmer Katelynn G, Van Harn Meredith, Haider Sameah, Hunt Rachel J, Cabral Glauber, Knight Robert A, Valadie O Grahm, Brown Stephen L, Ewing James R, Lee Ian Y
Neurosurgery, Wayne State University School of Medicine, Detroit, USA.
Neurosurgery, Henry Ford Health, Detroit, USA.
Cureus. 2023 Apr 10;15(4):e37397. doi: 10.7759/cureus.37397. eCollection 2023 Apr.
Purpose Laser interstitial thermal therapy (LITT) is a minimally invasive, image-guided, cytoreductive procedure to treat recurrent glioblastoma. This study implemented dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) methods and employed a model selection paradigm to localize and quantify post-LITT blood-brain barrier (BBB) permeability in the ablation vicinity. Serum levels of neuron-specific enolase (NSE), a peripheral marker of increased BBB permeability, were measured. Methods Seventeen patients were enrolled in the study. Using an enzyme-linked immunosorbent assay, serum NSE was measured preoperatively, 24 hours postoperatively, and at two, eight, 12, and 16 weeks postoperatively, depending on postoperative adjuvant treatment. Of the 17 patients, four had longitudinal DCE-MRI data available, from which blood-to-brain forward volumetric transfer constant (K) data were assessed. Imaging was performed preoperatively, 24 hours postoperatively, and between two and eight weeks postoperatively. Results Serum NSE increased at 24 hours following ablation (p=0.04), peaked at two weeks, and returned to baseline by eight weeks postoperatively. K was found to be elevated in the peri-ablation periphery 24 hours after the procedure. This increase persisted for two weeks. Conclusion Following the LITT procedure, serum NSE levels and peri-ablation K estimated from DCE-MRI demonstrated increases during the first two weeks after ablation, suggesting transiently increased BBB permeability.
目的 激光间质热疗（LITT）是一种用于治疗复发性胶质母细胞瘤的微创、图像引导的细胞减灭术。本研究采用动态对比增强磁共振成像（DCE-MRI）方法，并运用模型选择范式来定位和量化LITT术后消融区域附近的血脑屏障（BBB）通透性。测量了血清神经元特异性烯醇化酶（NSE）水平，其为BBB通透性增加的外周标志物。方法 17例患者纳入本研究。采用酶联免疫吸附测定法，根据术后辅助治疗情况，在术前、术后24小时以及术后2周、8周、12周和16周测量血清NSE。17例患者中，4例有纵向DCE-MRI数据，据此评估血脑正向容积转移常数（K）数据。术前、术后24小时以及术后2至8周进行成像。结果 消融后24小时血清NSE升高（p = 0.04），术后2周达到峰值，术后8周恢复至基线水平。术后24小时发现消融周边区域的K升高。这种升高持续了2周。结论 LITT术后，DCE-MRI估计的血清NSE水平和消融周边区域的K在消融后前两周升高，提示BBB通透性短暂增加。
