快速脑磁共振成像与常规临床磁共振成像在3级和4级胶质瘤患者中的诊断性能：一项初步研究
Diagnostic Performance of Fast Brain MRI Compared with Routine Clinical MRI in Patients with Glioma Grades 3 and 4: A Pilot Study.
作者信息
De Luca Francesca, Suneson Annika, Kits Annika, Palmér Emilia, Skare Stefan, Delgado Anna Falk
机构信息
From the Department of Clinical Neuroscience (F.D.L., A.K., S.S., A.F.D.), Karolinska Institutet, Stockholm, Sweden
Department of Radiology (F.D.L.), Karolinska University Hospital, Stockholm, Sweden.
出版信息
AJNR Am J Neuroradiol. 2025 May 2;46(5):983-989. doi: 10.3174/ajnr.A8558.
BACKGROUND AND PURPOSE
EPIMix is a fast brain MRI technique not previously investigated in patients with grade 3 and 4 gliomas. This pilot study aimed to investigate the diagnostic performance of EPIMix in the radiological treatment evaluation of adult patients with grade 3 and 4 gliomas compared with routine clinical MRI (rcMRI).
MATERIALS AND METHODS
Patients with grade 3 and 4 gliomas investigated with rcMRI and EPIMix were retrospectively included in the study. Three readers (R1-R3) participated in the radiological assessment applying the Response Assessment for Neuro-Oncology (RANO 2.0) criteria, of whom two (R1 and R2) independently evaluated EPIMix and later rcMRI by measuring contrast-enhancing and non-contrast-enhancing tumor regions at each follow-up. For cases with discrepant evaluations, an unblinded side-by-side (EPIMix and rcMRI) reading was performed together with a third reader (R3). Comparisons between methods (EPIMix versus rcMRI) were performed using the weighted Cohen κ. The sensitivity and specificity to progressive disease (PD) on a follow-up scan were calculated for EPIMix compared with rcMRI with receiver operating characteristic curves (ROC) to assess the area under the curve (AUC).
RESULTS
Of 35 patients (mean age, 53 years; 31% women), a total of 93 MRIs encompassing 58 follow-up investigations showed PD at a blinded reading in 33% of EPIMix (19/58, R1-2), while in 31% (18/58 exams, R1), and 34% (20/58 exams, R2) of rcMRI. An almost perfect agreement for tumor category assessment was found between EPIMix and rcMRI (EPIMixR1 versus rcMRIR1 κ = 0.96; EPIMixR2 versus rcMRIR2 κ = 0.89). The sensitivity for EPIMix to detect PD was 1.00 (0.81-1.00) for R1 and 0.90 (0.68-0.99) for R2, while the specificity was 0.97 (0.86-1.00) for R1 and R2. The AUC for PD was 0.99 for R1 (EPIMixR1 versus rcMRIR1) and 0.94 for R2 (EPIMixR2 versus rcMRIR2). The value of the DeLong test AUCR1 versus AUCR2 was = .20 (R1-R2).
CONCLUSIONS
In this pilot study, EPIMix was used as a fast MRI alternative for treatment evaluation of patients with glioma grades 3 and 4, with high but slightly lower diagnostic performance than rcMRI.
背景与目的
EPIMix是一种快速脑磁共振成像（MRI）技术，此前尚未在3级和4级胶质瘤患者中进行研究。这项前瞻性研究旨在探讨与常规临床MRI（rcMRI）相比，EPIMix在成年3级和4级胶质瘤患者放射治疗评估中的诊断性能。
材料与方法
对接受rcMRI和EPIMix检查的3级和4级胶质瘤患者进行回顾性研究。三名阅片者（R1 - R3）参与了基于神经肿瘤学反应评估（RANO 2.0）标准的放射学评估，其中两名（R1和R2）通过在每次随访时测量强化和非强化肿瘤区域，独立评估EPIMix，随后评估rcMRI。对于评估结果存在差异的病例，与第三名阅片者（R3）一起进行非盲法并列（EPIMix和rcMRI）阅片。使用加权Cohen κ进行方法（EPIMix与rcMRI）之间的比较。通过绘制受试者工作特征曲线（ROC）计算EPIMix与rcMRI相比在随访扫描中对疾病进展（PD）的敏感性和特异性，以评估曲线下面积（AUC）。
结果
35例患者（平均年龄53岁；31%为女性），共93次MRI检查，包括58次随访检查，在盲法阅片中，EPIMix显示33%（19/58，R1 - 2）存在PD，而rcMRI显示31%（18/58次检查，R1）和34%（20/58次检查，R2）存在PD。在肿瘤类别评估方面，EPIMix与rcMRI之间发现了几乎完美的一致性（EPIMixR1与rcMRIR1 κ = 0.96；EPIMixR2与rcMRIR2 κ = 0.89）。R1对EPIMix检测PD的敏感性为1.00（0.81 - 1.00），R2为0.90（0.68 - 0.99），而R1和R2的特异性均为0.97（0.86 - 1.00）。R1（EPIMixR1与rcMRIR1）对PD的AUC为0.99，R2（EPIMixR2与rcMRIR2）为0.94。R1与R2的DeLong检验AUC差值为 = 0.20（R1 - R2）。
结论
在这项前瞻性研究中，EPIMix被用作3级和4级胶质瘤患者治疗评估的快速MRI替代方法，其诊断性能较高，但略低于rcMRI。
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