van den Elshout R, Ariëns B, Esmaeili M, Akkurt B, Mannil M, Meijer F J A, van der Kolk A G, Scheenen T W J, Henssen D
Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands.
AmsterdamUMC, Radiology and Nuclear Medicine, Amsterdam, Netherlands.
Neuroradiology. 2024 Dec;66(12):2143-2151. doi: 10.1007/s00234-024-03450-8. Epub 2024 Aug 17.
It is difficult to distinguish between tumor progression (TP) and treatment-related abnormalities (TRA) in treated glioblastoma patients via conventional MRI, but this distinction is crucial for treatment decision making. Glioblastoma is known to exhibit an invasive growth pattern along white matter architecture and vasculature. This study quantified lesion development patterns in treated glioblastoma lesions and their relation to white matter microstructure to distinguish TP from TRA.
Glioblastoma patients with confirmed TP or TRA with T1-weighted contrast-enhanced and DTI MR scans from two posttreatment follow-up timepoints were reviewed. The contrast-enhancing regions were segmented, and the regions were coregistered to the DTI data. Lesion increase vectors were categorized into two groups: parallel (0-20 degrees) and perpendicular (70-90 degrees) to white matter. FA-values were also extracted. To test for a statistically significant difference between the TP and TRA groups, a Mann‒Whitney U test was performed.
Of 73 glioblastoma patients, fifteen were diagnosed with TRA, whereas 58 patients suffered TP. TP had a 25.8% (95% CI 24.1%-27.6%) increase in parallel lesions, and TRA had a 25.4% (95% CI 20.9%-29.9%) increase in parallel lesions. The perpendicular increase was 14.7% for TP (95% CI 13.0%-16.4%) and 18.0% (95% CI 13.5%-22.5%) for TRA. These results were not significantly different (p = 0.978). FA value for TP showed to be 0.248 (SD = 0.054) and for TRA it was 0.231 (SD = 0.075), showing no statistically significant difference (p = 0.121).
Based on our results, quantifying posttreatment contrast-enhancing lesion development directionality with DTI in glioblastoma patients does not appear to effectively distinguish between TP and TRA.
对于接受治疗的胶质母细胞瘤患者，通过传统磁共振成像（MRI）难以区分肿瘤进展（TP）和治疗相关异常（TRA），但这种区分对于治疗决策至关重要。已知胶质母细胞瘤沿白质结构和脉管系统呈现浸润性生长模式。本研究对接受治疗的胶质母细胞瘤病灶的病变发展模式及其与白质微观结构的关系进行量化，以区分TP和TRA。
回顾了胶质母细胞瘤患者，这些患者在两个治疗后随访时间点进行了T1加权对比增强和扩散张量成像（DTI）磁共振扫描，且确诊为TP或TRA。对对比增强区域进行分割，并将这些区域与DTI数据进行配准。病变增加向量分为两组：与白质平行（0 - 20度）和垂直（70 - 90度）。还提取了分数各向异性（FA）值。为检验TP组和TRA组之间是否存在统计学显著差异，进行了曼-惠特尼U检验。
在73例胶质母细胞瘤患者中，15例被诊断为TRA，而58例患者出现TP。TP组平行病变增加25.8%（95%置信区间24.1% - 27.6%），TRA组平行病变增加25.4%（95%置信区间20.9% - 29.9%）。TP组垂直增加为14.7%（95%置信区间13.0% - 16.4%），TRA组为18.0%（95%置信区间13.5% - 22.5%）。这些结果无显著差异（p = 0.978）。TP组的FA值为0.248（标准差 = 0.054），TRA组为0.231（标准差 = 0.075），无统计学显著差异（p = 0.121）。
基于我们的结果，在胶质母细胞瘤患者中利用DTI量化治疗后对比增强病变的发展方向性似乎无法有效区分TP和TRA。
