Choi Kyu Sung, Hwang Inpyeong, Park Chul Kee, Park Sung Hye, Choi Seung Hong
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Magn Reson Imaging. 2025 Apr;61(4):1751-1760. doi: 10.1002/jmri.29586. Epub 2024 Sep 5.
The specific patterns of subependymal enhancement (SE) that frequently occur as radiation-induced changes in high-grade gliomas following radiotherapy are often overlooked. Perfusion MRI may offer a diagnostic clue.
To distinguish between radiation-induced SE and progression in adult high-grade diffuse gliomas after standard treatment.
Retrospective.
Ninety-four consecutive high-grade diffuse glioma patients (mean age, 55 ± 14 years; 54 [57.4%] males) with new SE identified in follow-up MRI after completion of surgery plus chemoradiation: progression (N = 74) vs. regression (N = 20).
FIELD STRENGTH/SEQUENCE: 3 T, gradient-echo dynamic susceptibility contrast-enhanced MRI, 3D gradient-echo contrast-enhanced T1-weighted imaging.
To differentiate between radiation changes and progression in SE evaluation, multivariable logistic regression was performed using significant variables among SE appearance interval, IDH mutation, morphological features, and rCBV. Cox regression was performed to predict the tumor progression. For the added value of the rCBV, a log-rank test was conducted between the multivariable logistic regression models with and without the rCBV.
Logistic regression, Cox regression, receiver operating characteristic analysis, log-rank test.
38.3% (36/94) patients had first specific SE (9.2 ± 9.5 months after surgery), which disappeared in 21.3% (20/94) after 5.8 ± 5.8 months after initial appearance on post-radiation MRI. IDH mutation, elongated, small lesions with lower rCBV tended to regress: IDH mutation, elongation, diameter, and rCBV_p95; odds ratio, 0.32, 1.92, 1.70, and 2.47, respectively. Qualitative evaluation of shape revealed that thin and curvilinear-shaped SE tended to regress, indicating a significant correlation with quantitative shape features (r = 0.31). In Cox regression, rCBV and lesion shape were significant (hazard ratio = 1.09 and 0.54, respectively). For sub-centimeter lesions, the rCBV showed added value in predicting outcomes (area under the curve, 0.873 vs. 0.836; log-rank test).
Smaller, elongated lesions with lower rCBV and IDH mutation are associated with regression when differentiating radiation changes from progression in high-grade glioma with post-radiotherapy SE.
3 TECHNICAL EFFICACY: Stage 2.
高级别胶质瘤放疗后常出现的脑室管膜下强化（SE）的特定模式常被忽视。灌注磁共振成像（MRI）可能提供诊断线索。
区分成人高级别弥漫性胶质瘤标准治疗后辐射诱导的SE与病情进展。
回顾性研究。
94例连续的高级别弥漫性胶质瘤患者（平均年龄55±14岁；54例[57.4%]为男性），在手术加放化疗完成后的随访MRI中发现新的SE：病情进展组（N = 74）与病情消退组（N = 20）。
场强/序列：3T，梯度回波动态磁敏感对比增强MRI，三维梯度回波对比增强T1加权成像。
为在SE评估中区分辐射变化与病情进展，使用SE出现间隔、异柠檬酸脱氢酶（IDH）突变、形态学特征和相对脑血容量（rCBV）中的显著变量进行多变量逻辑回归分析。进行Cox回归分析以预测肿瘤进展。对于rCBV的附加值，在有和没有rCBV的多变量逻辑回归模型之间进行对数秩检验。
逻辑回归、Cox回归、受试者工作特征分析、对数秩检验。
38.3%（36/94）的患者首次出现特定SE（手术后9.2±9.5个月），在放疗后MRI上首次出现后5.8±5.8个月，21.3%（20/94）的患者SE消失。IDH突变、细长的小病变且rCBV较低往往会消退：IDH突变、延长、直径和rCBV_p95；优势比分别为0.32、1.92、1.70和2.47。对形状的定性评估显示，薄的和曲线形的SE往往会消退，表明与定量形状特征有显著相关性（r = 0.31）。在Cox回归分析中，rCBV和病变形状具有显著性（风险比分别为1.09和0.54）。对于小于1厘米的病变，rCBV在预测结果方面显示出附加值（曲线下面积分别为0.873和0.836；对数秩检验）。
在区分放疗后SE的高级别胶质瘤的辐射变化与病情进展时，较小、细长的病变且rCBV较低以及IDH突变与病情消退相关。
3级 技术效能：2级
