Reyes Soto Gervith, Vega-Moreno Daniel Alejandro, Catillo-Rangel Carlos, González-Aguilar Alberto, Chávez-Martínez Oswaldo Alan, Nikolenko Vladimir, Nurmukhametov Renat, Rosario Rosario Andreina, García-González Ulises, Arellano-Mata Alfonso, Furcal Aybar Mario Antonio, Encarnacion Ramirez Manuel de Jesus
Neurosurgical Oncology, Mexico National Cancer Institute, Tlalpan, MEX.
Neurosciences Unit, National Cancer Institute, Mexico City, MEX.
Cureus. 2024 Nov 3;16(11):e72942. doi: 10.7759/cureus.72942. eCollection 2024 Nov.
Metastatic brain tumors are a prevalent challenge in neurosurgery, with vasogenic edema being a significant consequence of these lesions. Despite the critical role of peritumoral edema in prognosis and patient outcomes, few studies have quantified its diagnostic and prognostic implications. This study aims to evaluate the correlation between the edema/tumor index (ETI) and histopathological outcomes according to the 2021 WHO classification of cranial tumors.
We conducted a retrospective analysis of Digital Imaging and Communications in Medicine (DICOM)-format magnetic resonance imaging (MRI) data from May 2023 to May 2024, applying manual 3D volumetric segmentation using Image Tool Kit-SNAP (ITK-SNAP, version 3.8.0, University of Pennsylvania) software. The ETI was calculated by dividing the volume of peritumoral edema by the tumor volume. The study included 60 patients, and statistical analyses were performed to assess the correlation between ETI and tumor histopathology, including Receiver Operating Characteristic (ROC) curve analysis for cutoff points.
A total of 60 patients were included in the study, with 27 males (45%) and 33 females (55%). The average tumor volume measured by 3D segmentation was 46.9 cubic centimeters (cc) (standard deviation [SD] ± 25.6), and the average peritumoral edema volume was 79 cc (SD ± 37.5) for malignant tumors. The ETI was calculated for each case. Malignant tumors (WHO grades 3 and 4) had a mean ETI of 1.6 (SD ± 1.2), while non-malignant tumors (WHO grades 1 and 2) had a mean ETI of 1.2 (SD ± 1.1), but this difference was not statistically significant ( = 0.51). ROC curve analysis for the ETI did not provide a reliable cutoff point for predicting tumor malignancy (area under the curve [AUC] = 0.59, = 0.20). Despite the larger edema volume observed in malignant tumors, the ETI did not correlate significantly with the histopathological grade.
This study found no significant correlation between the ETI and the histopathological grade of brain tumors according to the 2021 WHO classification. While malignant tumors were associated with larger volumes of both tumor and peritumoral edema, the ETI did not prove to be a reliable predictor of tumor malignancy. Therefore, the ETI should not be used as a standalone metric for determining tumor aggressiveness or guiding clinical decision-making. Further studies with larger cohorts are required to better understand the potential prognostic value of the ETI in brain tumors.
转移性脑肿瘤是神经外科领域普遍存在的挑战，血管源性水肿是这些病变的一个重要后果。尽管瘤周水肿在预后和患者结局中起着关键作用，但很少有研究对其诊断和预后意义进行量化。本研究旨在根据2021年世界卫生组织（WHO）颅内肿瘤分类评估水肿/肿瘤指数（ETI）与组织病理学结果之间的相关性。
我们对2023年5月至2024年5月以医学数字成像和通信（DICOM）格式存储的磁共振成像（MRI）数据进行了回顾性分析，使用图像工具包-SNAP（ITK-SNAP，宾夕法尼亚大学3.8.0版本）软件进行手动三维容积分割。ETI通过将瘤周水肿体积除以肿瘤体积来计算。该研究纳入了60例患者，并进行了统计分析以评估ETI与肿瘤组织病理学之间的相关性，包括用于确定临界值的受试者操作特征（ROC）曲线分析。
该研究共纳入60例患者，其中男性27例（45%），女性33例（55%）。通过三维分割测量的平均肿瘤体积为46.9立方厘米（cc）（标准差[SD]±25.6），恶性肿瘤的平均瘤周水肿体积为79 cc（SD±37.5）。计算了每个病例的ETI。恶性肿瘤（WHO 3级和4级）的平均ETI为1.6（SD±1.2），而非恶性肿瘤（WHO 1级和2级）的平均ETI为1.2（SD±1.1），但这种差异无统计学意义（P = 0.51）。ETI的ROC曲线分析未提供预测肿瘤恶性程度的可靠临界值（曲线下面积[AUC]=0.59，P = 0.20）。尽管在恶性肿瘤中观察到更大的水肿体积，但ETI与组织病理学分级无显著相关性。
本研究发现，根据2021年WHO分类，ETI与脑肿瘤的组织病理学分级之间无显著相关性。虽然恶性肿瘤与更大的肿瘤体积和瘤周水肿相关，但ETI并未被证明是肿瘤恶性程度的可靠预测指标。因此，ETI不应作为确定肿瘤侵袭性或指导临床决策的独立指标。需要进行更大样本量的进一步研究，以更好地了解ETI在脑肿瘤中的潜在预后价值。
