Hu Xing, Zhang Gaobo, Xie Rong, Wang Yong, Zhu Yingfeng, Ding Hong
Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Academy for Engineering and Technology, Fudan University, Shanghai, 200438, China.
J Ultrasound. 2025 Mar;28(1):63-74. doi: 10.1007/s40477-024-00961-1. Epub 2024 Nov 4.
The objective of this study is to assess the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in determining the level of glioma infiltration and to investigate its correlation with pathological markers.
A prospective study involving 16 adult glioma patients was conducted. Preoperative US-(Magnetic Resonance)MR fusion imaging was utilized for tumor infiltration localization, while CEUS was employed to assess hemodynamic alterations. Parameters such as peak intensity (PI), rise time (RT), time to peak (TTP), and area under the curve (AUC) were measured. Utilizing contralateral normal brain tissue as the reference standard. The Kruskal-Wallis H-test was conducted to compare CEUS and pathological parameters (significance level, p < 0.05; bonferroni correction) among tumor margins, infiltration zones, and normal tissues, as well as between low-grade glioma (LGG) and high-grade glioma (HGG) within the infiltration zone, based on whole slide pathological images analysis. Spearman correlation analysis was employed to determine the correlation coefficient between hemodynamics and pathology. Receiver operating characteristic (ROC) curves were drawn to evaluate the performance of CEUS in tumor classification.
From tumor margin to normal tissue, PI, AUC, Ki67, EGFR, and 1p/19q showed a significant decreasing trend, while TTP, IDH-1, and MGMT gradually increased. RT was lower at the tumor margin but did not show statistically significant differences. In the infiltration zones, there was a significant increase in parameters such as PI, normalized PI (Nor_PI), AUC, and Ki67 from LGG to HGG, while RT, Nor_RT, TTP, Nor_TTP, IDH-1, and MGMT significantly decreased. Nor_AUC and EGFR increased but were not significant, and 1p/19q decreased but was not significant. RT and Nor_TTP were independent risk factors for distinguishing between LGG and HGG in the infiltration zone, with a combined diagnostic efficacy ROC of 0.891. The sensitivity reached 96.64% and the specificity reached 82.35%. There was a significant correlation between hemodynamic indicators and pathological indicators. CEUS can effectively differentiate levels of infiltration zones, which correlates with their biological behavior, with RT + Nor_TTP showing particularly highest diagnostic efficacy.
These findings contribute to improving the accuracy of diagnosing infiltration zones and provide essential biological insights for subsequent treatments.
本研究的目的是评估超声造影（CEUS）在确定胶质瘤浸润程度方面的诊断效能，并研究其与病理标志物的相关性。
对16例成年胶质瘤患者进行了一项前瞻性研究。术前采用超声-（磁共振）MR融合成像进行肿瘤浸润定位，同时采用CEUS评估血流动力学改变。测量峰值强度（PI）、上升时间（RT）、达峰时间（TTP）和曲线下面积（AUC）等参数。以对侧正常脑组织作为参考标准。基于全切片病理图像分析，采用Kruskal-Wallis H检验比较肿瘤边缘、浸润区和正常组织之间以及浸润区内低级别胶质瘤（LGG）和高级别胶质瘤（HGG）之间的CEUS和病理参数（显著性水平，p < 0.05；Bonferroni校正）。采用Spearman相关分析确定血流动力学与病理学之间的相关系数。绘制受试者工作特征（ROC）曲线以评估CEUS在肿瘤分类中的性能。
从肿瘤边缘到正常组织，PI、AUC、Ki67、EGFR和1p/19q呈显著下降趋势，而TTP、IDH-1和MGMT逐渐升高。RT在肿瘤边缘较低，但无统计学显著差异。在浸润区，从LGG到HGG，PI、归一化PI（Nor_PI）、AUC和Ki67等参数显著增加，而RT、Nor_RT、TTP、Nor_TTP、IDH-1和MGMT显著降低。Nor_AUC和EGFR升高但不显著，1p/19q降低但不显著。RT和Nor_TTP是区分浸润区内LGG和HGG的独立危险因素，联合诊断效能ROC为0.891。敏感性达到96.64%，特异性达到82.35%。血流动力学指标与病理指标之间存在显著相关性。CEUS能够有效区分浸润区的程度，这与其生物学行为相关，其中RT + Nor_TTP显示出特别高的诊断效能。
这些发现有助于提高浸润区诊断的准确性，并为后续治疗提供重要的生物学见解。
