脑血流与组织学分析用于胶质母细胞瘤中浸润性肿瘤与血管源性水肿的准确鉴别
Cerebral blood flow and histological analysis for the accurate differentiation of infiltrating tumor and vasogenic edema in glioblastoma.
作者信息
Kuroda Hideki, Okita Yoshiko, Arisawa Atsuko, Utsugi Reina, Murakami Koki, Hirayama Ryuichi, Kijima Noriyuki, Arita Hideyuki, Kinoshita Manabu, Fujimoto Yasunori, Nakamura Hajime, Kagawa Naoki, Tomiyama Noriyuki, Kishima Haruhiko
机构信息
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Diagnostic Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
出版信息
PLoS One. 2025 Jan 10;20(1):e0316168. doi: 10.1371/journal.pone.0316168. eCollection 2025.
BACKGROUND
Glioblastoma is characterized by neovascularization and diffuse infiltration into the adjacent tissue. T2*-based dynamic susceptibility contrast (DSC) MR perfusion images provide useful measurements of the biomarkers associated with tumor perfusion. This study aimed to distinguish infiltrating tumors from vasogenic edema in glioblastomas using DSC-MR perfusion images.
METHODS
Data were retrospectively collected from 48 patients with primary IDH-wild-type glioblastoma and 24 patients with meningiomas (Edemas-M). First, we attempted histological verification of cell density, Ki-67 index, and microvessel areas to distinguish between non-contrast-enhancing tumors (NETs) and edema (Edemas) which were obtained from stereotactically fused T2-weighted and perfusion images. This was performed for evaluating enhancing tumors (ETs), NETs, and Edemas. Second, we also performed radiological verification to distinguish NETs from Edemas. Two neurosurgeons manually assigned the regions of interests (ROIs) to ETs, NETs, and Edemas. The DSC-MR perfusion imaging-derived parameters calculated for each ROI included the cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT).
RESULTS
Cell density and microvessel area were significantly higher in NETs than those in Edemas (p<0.01 and p<0.05, respectively). Regarding radiological analysis, the mean CBF ratio for Edemas was significantly lower than that for NETs (p<0.01). The mean MTT ratio for Edemas was significantly higher than that for NETs. The receiver operating characteristic (ROC) analysis showed that CBF (area under the curve [AUC] = 0.890) could effectively distinguish between NETs and Edemas. The ROC analysis also showed that MTT (AUC = 0.946) could effectively distinguish between NETs and Edemas.
CONCLUSIONS
DSC-MR perfusion images may prove useful in differentiating NETs from Edemas in non-contrast T2 hyperintensity regions of glioblastoma.
背景
胶质母细胞瘤的特征是新生血管形成以及向邻近组织的弥漫性浸润。基于T2*的动态磁敏感对比（DSC）磁共振灌注成像可对与肿瘤灌注相关的生物标志物进行有用的测量。本研究旨在利用DSC磁共振灌注成像区分胶质母细胞瘤中的浸润性肿瘤与血管源性水肿。
方法
回顾性收集48例原发性异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤患者和24例脑膜瘤患者（水肿-M）的数据。首先，我们尝试对细胞密度、Ki-67指数和微血管面积进行组织学验证，以区分从立体定向融合的T2加权和灌注图像中获得的非强化肿瘤（NETs）和水肿（Edemas）。这是为了评估强化肿瘤（ETs）、NETs和Edemas。其次，我们还进行了影像学验证以区分NETs和Edemas。两名神经外科医生手动将感兴趣区域（ROIs）指定给ETs、NETs和Edemas。为每个ROI计算的DSC磁共振灌注成像衍生参数包括脑血容量（CBV）、脑血流量（CBF）和平均通过时间（MTT）。
结果
NETs中的细胞密度和微血管面积显著高于Edemas（分别为p<0.01和p<0.05）。关于影像学分析，Edemas的平均CBF比值显著低于NETs（p<0.01）。Edemas的平均MTT比值显著高于NETs。受试者工作特征（ROC）分析表明，CBF（曲线下面积[AUC]=0.890）可有效区分NETs和Edemas。ROC分析还表明，MTT（AUC=0.946）可有效区分NETs和Edemas。
结论
DSC磁共振灌注成像可能有助于在胶质母细胞瘤的非强化T2高信号区域区分NETs和Edemas。
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