Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
Radboudumc Center of Expertise Neuro-Oncology, Nijmegen, The Netherlands.
Neuroradiology. 2024 Aug;66(8):1279-1289. doi: 10.1007/s00234-024-03374-3. Epub 2024 May 8.
Dynamic susceptibility contrast (DSC) perfusion weighted (PW)-MRI can aid in differentiating treatment related abnormalities (TRA) from tumor progression (TP) in post-treatment glioma patients. Common methods, like the 'hot spot', or visual approach suffer from oversimplification and subjectivity. Using perfusion of the complete lesion potentially offers an objective and accurate alternative. This study aims to compare the diagnostic value and assess the subjectivity of these techniques.
50 Glioma patients with enhancing lesions post-surgery and chemo-radiotherapy were retrospectively included. Outcome was determined by clinical/radiological follow-up or biopsy. Imaging analysis used the 'hot spot', volume of interest (VOI) and visual approach. Diagnostic accuracy was compared using receiving operator characteristics (ROC) curves for the VOI and 'hot spot' approach, visual assessment was analysed with contingency tables. Inter-operator agreement was determined with Cohens kappa and intra-class coefficient (ICC).
29 Patients suffered from TP, 21 had TRA. The visual assessment showed poor to substantial inter-operator agreement (κ = -0.72 - 0.68). Reliability of the 'hot spot' placement was excellent (ICC = 0.89), while reference placement was variable (ICC = 0.54). The area under the ROC (AUROC) of the mean- and maximum relative cerebral blood volume (rCBV) (VOI-analysis) were 0.82 and 0.72, while the rCBV-ratio ('hot spot' analysis) was 0.69. The VOI-analysis had a more balanced sensitivity and specificity compared to visual assessment.
VOI analysis of DSC PW-MRI data holds greater diagnostic accuracy in single-moment differentiation of TP and TRA than 'hot spot' or visual analysis. This study underlines the subjectivity of visual placement and assessment.
动态对比增强磁共振灌注成像（DSC-PW-MRI）可辅助鉴别治疗后胶质瘤患者的治疗相关性异常（TRA）与肿瘤进展（TP）。常见方法如“热点”或视觉法存在过度简化和主观性的问题。采用完整病变的灌注可能提供一种客观准确的替代方法。本研究旨在比较这些技术的诊断价值和评估其主观性。
回顾性纳入 50 例术后放化疗后出现增强病变的胶质瘤患者。通过临床/影像学随访或活检确定结果。采用“热点”、感兴趣区（VOI）和视觉法进行影像分析。通过 VOI 和“热点”法的接收者操作特征（ROC）曲线比较诊断准确性，采用列联表分析视觉评估，采用 Cohen's kappa 和组内相关系数（ICC）评估观察者间一致性。
29 例患者发生 TP，21 例患者发生 TRA。视觉评估显示观察者间一致性较差到中等（κ=-0.72 至-0.68）。“热点”放置的可靠性极好（ICC=0.89），而参考放置的可靠性可变（ICC=0.54）。VOI 分析的平均和最大相对脑血容量（rCBV）的 ROC 曲线下面积（AUROC）分别为 0.82 和 0.72，而“热点”分析的 rCBV 比值为 0.69。与视觉评估相比，VOI 分析在单一时刻鉴别 TP 和 TRA 方面具有更高的诊断准确性。
与“热点”或视觉分析相比，DSC-PW-MRI 数据的 VOI 分析在单一时刻鉴别 TP 和 TRA 方面具有更高的诊断准确性。本研究强调了视觉放置和评估的主观性。
