Department of Medical Imaging Center, Jinan University First Affiliated Hospital, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
Department of Oncology, Guangdong sanjiu Brain Hospital, No. 578, Shatai South Road, Baiyun District, Guangzhou, 510510, Guangdong Province, China.
Eur Radiol. 2024 Dec;34(12):7962-7972. doi: 10.1007/s00330-024-10855-9. Epub 2024 Jun 21.
An easy-to-implement MRI model for predicting partial response (PR) postradiotherapy for diffuse intrinsic pontine glioma (DIPG) is lacking. Utilizing quantitative T2 signal intensity and introducing a visual evaluation method based on T2 signal intensity heterogeneity, and compared MRI radiomic models for predicting radiotherapy response in pediatric patients with DIPG.
We retrospectively included patients with brainstem gliomas aged ≤ 18 years admitted between July 2011 and March 2023. Applying Response Assessment in Pediatric Neuro-Oncology criteria, we categorized patients into PR and non-PR groups. For qualitative analysis, tumor heterogeneity vision was classified into four grades based on T2-weighted images. Quantitative analysis included the relative T2 signal intensity ratio (rT2SR), extra pons volume ratio, and tumor ring-enhancement volume. Radiomic features were extracted from T2-weighted and T1-enhanced images of volumes of interest. Univariate analysis was used to identify independent variables related to PR. Multivariate logistic regression was performed using significant variables (p < 0.05) from univariate analysis.
Of 140 patients (training n = 109, and test n = 31), 64 (45.7%) achieved PR. The AUC of the predictive model with extrapontine volume ratio, rT2SRmax-min (rT2SR), and grade was 0.89. The AUCs of the T2-weighted and T1WI-enhanced models with radiomic signatures were 0.84 and 0.81, respectively. For the 31 DIPG test sets, the AUCs were 0.91, 0.83, and 0.81, for the models incorporating the quantitative features, radiomic model (T2-weighted images, and T1W1-enhanced images), respectively.
Combining T2-weighted quantification with qualitative and extrapontine volume ratios reliably predicted pediatric DIPG radiotherapy response.
Combining T2-weighted quantification with qualitative and extrapontine volume ratios can accurately predict diffuse intrinsic pontine glioma (DIPG) radiotherapy response, which may facilitate personalized treatment and prognostic assessment for patients with DIPG.
Early identification is crucial for radiotherapy response and risk stratification in diffuse intrinsic pontine glioma. The model using tumor heterogeneity and quantitative T2 signal metrics achieved an AUC of 0.91. Using a combination of parameters can effectively predict radiotherapy response in this population.
目前缺乏一种易于实施的磁共振成像（MRI）模型来预测接受放疗后弥漫性内在脑桥胶质瘤（DIPG）的部分缓解（PR）。本研究利用定量 T2 信号强度，并引入基于 T2 信号强度异质性的视觉评估方法，比较了用于预测儿科 DIPG 患者放疗反应的 MRI 放射组学模型。
我们回顾性纳入了 2011 年 7 月至 2023 年 3 月期间入院的年龄≤18 岁的脑干胶质瘤患者。根据儿童神经肿瘤放射治疗反应评估标准，我们将患者分为 PR 组和非 PR 组。定性分析方面，根据 T2 加权图像将肿瘤异质性视觉分为 4 个等级。定量分析包括相对 T2 信号强度比（rT2SR）、桥外体积比和肿瘤环形增强体积。从感兴趣容积的 T2 加权和 T1 增强图像中提取放射组学特征。单变量分析用于确定与 PR 相关的独立变量。使用单变量分析中具有统计学意义的变量（p<0.05）进行多变量逻辑回归。
在 140 名患者（训练集 n=109，测试集 n=31）中，64 名（45.7%）患者达到 PR。包含桥外体积比、rT2SRmax-min（rT2SR）和分级的预测模型的 AUC 为 0.89。基于放射组学特征的 T2 加权和 T1WI 增强模型的 AUC 分别为 0.84 和 0.81。对于 31 个 DIPG 测试集，包含定量特征、放射组学模型（T2 加权图像和 T1W1 增强图像）的模型的 AUC 分别为 0.91、0.83 和 0.81。
定量 T2 加权与定性和桥外体积比相结合可可靠地预测儿科 DIPG 放疗反应。
定量 T2 加权与定性和桥外体积比相结合可以准确预测弥漫性内在脑桥胶质瘤（DIPG）放疗反应，这可能有助于为 DIPG 患者提供个性化治疗和预后评估。
早期识别对于弥漫性内在脑桥胶质瘤的放疗反应和风险分层至关重要。使用肿瘤异质性和定量 T2 信号指标的模型获得了 0.91 的 AUC。使用参数组合可以有效地预测该人群的放疗反应。
