Henriksen Otto Mølby, Muhic Aida, Lundemann Michael Juncker, Larsson Henrik Bo Wiberg, Lindberg Ulrich, Andersen Thomas Lund, Hasselbalch Benedikte, Møller Søren, Marner Lisbeth, Madsen Karine, Larsen Vibeke Andrée, Poulsen Hans Skovgaard, Hansen Adam Espe, Law Ian
Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Neurooncol Adv. 2024 Nov 18;6(1):vdae196. doi: 10.1093/noajnl/vdae196. eCollection 2024 Jan-Dec.
Magnetic resonance imaging (MRI) cerebral blood volume (CBV) measurements improve the diagnosis of recurrent gliomas. The study investigated the prognostic value of dynamic contrast-enhanced (DCE) CBV imaging in treated IDH wildtype glioblastoma when added to MRI or amino acid positron emission tomography (PET).
Hybrid [F]FET PET/MRI with 2CXM (2-compartment exchange model) DCE from 86 adult patients with suspected recurrent or residual glioblastoma were retrospectively analyzed. High CBV tumor volume (VOL), and contrast-enhancing (VOL) and [F]FET active tumor (VOL) volumes were delineated. Absolute and fractional high CBV subvolumes within VOL and VOL were determined. Associations with overall survival (OS) were assessed by Cox analysis.
Adjusted for methyltransferase gene status and steroid use all total tumor volumes were individually associated with shorter OS. Adding VOL to VOL or VOL only the effect of VOL was prognostic of OS (hazard ratio [HR] 1.327, = .042 and 1.352, = .011, respectively). High CBV subvolumes within both VOL and VOL were associated with shorter survival (HR 1.448, = .042 and 1.416, = .011, respectively), and the low CBV subvolumes with longer survival (HR 0.504, = .002 and .365, = .001, respectively). The fraction of VOL and VOL with high CBV was a strong predictor of OS with shorter median OS in upper versus lower tertiles (8.3 vs 14.5 months and 7.1 vs 15.6 months, respectively, both < .001).
The high CBV tumor volume was a strong prognosticator of survival and allowed for the separation of high- and low-risk subvolumes underlining the heterogeneous physiological environment represented in the contrast-enhancing or metabolically active tumor volumes of treated glioblastoma.
磁共振成像（MRI）脑血容量（CBV）测量可改善复发性胶质瘤的诊断。本研究调查了动态对比增强（DCE）CBV成像在添加到MRI或氨基酸正电子发射断层扫描（PET）时，对经治疗的异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤的预后价值。
对86例疑似复发性或残留性胶质母细胞瘤的成年患者的采用2CXM（双室交换模型）DCE的混合[F]FET PET/MRI进行回顾性分析。划定高CBV肿瘤体积（VOL）、强化（VOL）和[F]FET活性肿瘤（VOL）体积。确定VOL和VOL内的绝对和分数高CBV子体积。通过Cox分析评估与总生存期（OS）的关联。
校正甲基转移酶基因状态和类固醇使用情况后，所有肿瘤总体积均与较短的OS独立相关。将VOL添加到VOL或仅添加VOL时，VOL的影响对OS具有预后意义（风险比[HR]分别为1.327，P = 0.042和1.352，P = 0.011）。VOL和VOL内的高CBV子体积均与较短生存期相关（HR分别为1.448，P = 0.042和1.416，P = 0.011），而低CBV子体积与较长生存期相关（HR分别为0.504，P = 0.002和0.365，P = 0.001）。VOL和VOL中高CBV的比例是OS的强预测指标，上三分位数与下三分位数的中位OS较短（分别为8.3个月对14.5个月和7.1个月对15.6个月，P均<0.001）。
高CBV肿瘤体积是生存的强预后指标，并能够区分高风险和低风险子体积，突显了经治疗的胶质母细胞瘤强化或代谢活跃肿瘤体积中所代表的异质生理环境。
