Liu Dun, Liu Wei
Altern Ther Health Med. 2023 Oct 27.
Glioblastoma is a highly invasive brain tumor, and its treatment and management have long posed challenges in the fields of neurosurgery and oncology. This study aimed to explore the potential value of apparent diffusion coefficient (ADC) values in postoperative recurrent brain gliomas using magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI), with the goal of providing clinicians with more precise decision-making tools. In the context of the therapeutic challenges posed by glioblastomas, this research holds significant importance. The treatment of glioblastomas typically involves surgical resection, radiotherapy, and chemotherapy; however, its recurrence rate remains relatively high. Early detection of recurrence is crucial for implementing timely interventions, as it can impact patient survival and quality of life. ADC values within DWI may serve as a non-invasive tool to aid in the identification of potential recurrent lesions, thereby facilitating earlier therapeutic actions.
A retrospective analysis was conducted on clinical data from 52 patients diagnosed with brain gliomas. All patients underwent MRI scans, contrast-enhanced imaging, and DWI. Based on the pathology results from the second surgery or radiological follow-up, patients were categorized into two groups: the recurrent group (31 cases) and the non-recurrent group (21 cases). The MRI diagnostic criteria followed the Chinese Guidelines for Diagnosis and Treatment of Central Nervous System Gliomas (2015 edition), and gliomas were classified into grades I-IV according to the WHO (2007 edition) pathological grading standards. Inclusion criteria encompassed postoperative pathological diagnosis of brain gliomas, absence of intracranial surgeries, brain parenchymal injuries, or other relevant medical histories, and all patients received postoperative adjuvant radiotherapy with a total dose exceeding 50 Gy, coupled with chemotherapy. Exclusion criteria excluded patients diagnosed with cerebral infarction, those with other intracranial conditions such as intracranial hypertension, and individuals with hepatic or renal dysfunction or known contrast agent allergies. ADC values for both groups were separately calculated, and receiver operating characteristic (ROC) curves were constructed. ROC area under the curve (AUC) was employed to assess the diagnostic accuracy of the two methods, along with the calculation of sensitivity (Sen) and specificity (Spe).
The ADCmean values (1.05 ± 0.25 mmys) and relative ADC (rADC)mean values (1.17 ± 0.38 mmys) of the recurrent group were lower than those of the non-recurrent group (1.33 ± 0.21 mmys, 1.36 ± 0.24 mmys), while the ADCmin values (1.03 ± 0.18 mmys) and ADCmax values (1.19 ± 0.21 mmys) of the recurrent group were lower than those of the non-recurrent group (1.21 ± 0.12 mmys, 1.35 ± 0.17 mmys), with statistically significant differences (P < .05). The AUC of ADCmean was 0.785, with Sen and Spe of 93.75% and 55%, respectively. The AUC of rADCmean was 0.702, with Sen and Spe of 86.2% and 65.21%, respectively. The AUC of ADCmin was 0.824, with Sen and Spe of 86.66% and 68.18%, respectively. The AUC of ADCmax is 0.715, with Sen and Spe of 77.77% and 60%, respectively.
The results of this study demonstrated the potential clinical utility of ADC values in the diagnosis of postoperative recurrence in gliomas. ROC analysis revealed that ADC values exhibited a high diagnostic accuracy, with the AUC reflecting their discriminative ability between the recurrence and non-recurrence groups. This finding may assist clinical practitioners in more precisely assessing patients' risk of recurrence, further optimizing treatment strategies, and enhancing both survival rates and quality of life. Nevertheless, it is important to acknowledge several limitations in this study. Firstly, the relatively small sample size may limit the generalizability of the results. Additionally, due to the observational nature of this study, larger-scale and multicenter research is still required to validate these findings. Lastly, ADC values are influenced by various factors, including technical parameters and equipment variations, which necessitate further standardization and calibration efforts. Thus, while the results of this study hold promise for improving the management of glioma patients, further research is warranted to fully understand their potential clinical value.
胶质母细胞瘤是一种具有高度侵袭性的脑肿瘤，其治疗与管理长期以来一直是神经外科和肿瘤学领域的难题。本研究旨在利用磁共振成像（MRI）扩散加权成像（DWI）探讨表观扩散系数（ADC）值在术后复发性脑胶质瘤中的潜在价值，旨在为临床医生提供更精确的决策工具。在胶质母细胞瘤带来的治疗挑战背景下，本研究具有重要意义。胶质母细胞瘤的治疗通常包括手术切除、放疗和化疗；然而，其复发率仍然相对较高。早期发现复发对于及时实施干预至关重要，因为这会影响患者的生存和生活质量。DWI中的ADC值可作为一种非侵入性工具，有助于识别潜在的复发病变，从而促进更早的治疗行动。
对52例诊断为脑胶质瘤的患者临床资料进行回顾性分析。所有患者均接受了MRI扫描、增强成像和DWI检查。根据二次手术的病理结果或影像学随访，将患者分为两组：复发组（31例）和非复发组（21例）。MRI诊断标准遵循《中国中枢神经系统胶质瘤诊断与治疗指南（2015年版）》，胶质瘤根据WHO（2007年版）病理分级标准分为I-IV级。纳入标准包括脑胶质瘤的术后病理诊断、无颅内手术史、脑实质损伤或其他相关病史，且所有患者均接受了总剂量超过50 Gy的术后辅助放疗及化疗。排除标准排除诊断为脑梗死的患者、患有其他颅内疾病如颅内高压的患者以及有肝肾功能障碍或已知造影剂过敏的个体。分别计算两组的ADC值，并绘制受试者工作特征（ROC）曲线。采用曲线下面积（AUC）评估两种方法的诊断准确性，并计算敏感性（Sen）和特异性（Spe）。
复发组的ADCmean值（1.05±0.25 mmys）和相对ADC（rADC）mean值（1.17±0.38 mmys）低于非复发组（1.33±0.21 mmys，1.36±0.24 mmys），复发组的ADCmin值（1.03±0.18 mmys）和ADCmax值（1.19±0.21 mmys）低于非复发组（1.21±0.12 mmys，1.35±0.17 mmys），差异具有统计学意义（P<.05）。ADCmean的AUC为0.785，Sen和Spe分别为93.75%和55%。rADCmean的AUC为0.702，Sen和Spe分别为86.2%和65.21%。ADCmin的AUC为0.824，Sen和Spe分别为86.66%和68.18%。ADCmax的AUC为0.715，Sen和Spe分别为77.77%和60%。
本研究结果表明ADC值在胶质瘤术后复发诊断中具有潜在的临床应用价值。ROC分析显示，ADC值具有较高的诊断准确性，AUC反映了其在复发组和非复发组之间的鉴别能力。这一发现可能有助于临床医生更精确地评估患者的复发风险，进一步优化治疗策略，提高生存率和生活质量。然而，必须认识到本研究存在的几个局限性。首先，相对较小的样本量可能会限制结果的普遍性。此外，由于本研究的观察性质，仍需要大规模、多中心研究来验证这些发现。最后，ADC值受多种因素影响，包括技术参数和设备差异，这需要进一步的标准化和校准工作。因此，虽然本研究结果有望改善胶质瘤患者的管理，但仍需进一步研究以充分了解其潜在的临床价值。
