Timaran-Montenegro David, Nunez Luis, Dono Antonio, Arevalo Octavio, Rodriguez Andres, Khalaj Kamand, McCarty Jennifer, Zhu Jay-Jiguang, Esquenazi Yoshua, Riascos Roy
Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Acta Radiol. 2025 May;66(5):546-557. doi: 10.1177/02841851251316400. Epub 2025 Mar 13.
BackgroundExtent of resection (EOR), including gross total resection (GTR), is one of the most important factors in predicting overall survival (OS) in IDH-wild type (IDH-WT) glioblastoma patients. Although GTR represents the complete resection of all visible contrast-enhancing parts of the tumor, imaging predictors of achieving this extent still need to be better understood.PurposeTo assess the impact of preoperative imaging phenotypes as defined by the VASARI feature set and tumoral volumetry to determine predictors of GTR in patients with IDH-WT glioblastoma.Material and MethodsThis retrospective, single-center study analyzed imaging characteristics based on the VASARI features in the preoperative scans of IDH-WT glioblastoma patients. Volumetric analysis was performed to determine associations with clinical outcomes. Univariate analysis was used to determine the association of VASARI features with GTR. A multivariate analysis model was used to determine predictors of GTR.ResultsGTR was achieved in 79/144 (54.8%) patients, near total resection in 15 (10.4%), and subtotal resection in 50 (34.7%) patients. Our results showed non-eloquent tumor regions (55% vs. 35%; = 0.04) and thick margin of enhancement (56.1% vs. 43.9%; = 0.04) were associated with GTR and ependymal extension (37% vs. 63%; = 0.02). Deep white matter invasion (36.3% vs. 63.7%; = 0.03) was significantly associated with non-gross total resection. Lower tumoral volumes were also associated with gross total resection (< 0.01). After performing multivariate analysis, the thickness of the tumoral enhancing margins was correlated with GTR with an OR of 1.57 (95% CI=1.1-2.23). Furthermore, the volume of the enhancing component was significantly different according to EOR with a calculated OR of 0.95 (95% CI = 0.92-0.97; < 0.01).ConclusionImaging characteristics on standard-of-care MRI can predict the rate of GTR in patients with IDH-WT glioblastomas. The thickness of enhancing margins predicts GTR after multivariate analysis. A diagnostic model that includes a combination of the discriminating depicted features on MRI and brain tumor volumetrics has an acceptable diagnostic performance with a specificity >90%.
背景
切除范围（EOR），包括全切除（GTR），是预测异柠檬酸脱氢酶野生型（IDH-WT）胶质母细胞瘤患者总生存期（OS）的最重要因素之一。尽管GTR代表肿瘤所有可见强化部分的完全切除，但实现这一切除范围的影像学预测指标仍有待深入了解。
目的
评估由VASARI特征集和肿瘤体积测定法定义的术前影像表型对确定IDH-WT胶质母细胞瘤患者GTR预测指标的影响。
材料与方法
这项回顾性单中心研究分析了IDH-WT胶质母细胞瘤患者术前扫描基于VASARI特征的影像特征。进行体积分析以确定与临床结果的相关性。采用单因素分析确定VASARI特征与GTR的相关性。使用多因素分析模型确定GTR的预测指标。
结果
144例患者中，79例（54.8%）实现了GTR，15例（10.4%）为近全切除，50例（34.7%）为次全切除。我们的结果显示，非功能区肿瘤（55%对35%；P = 0.04）和强化边缘增厚（56.1%对43.9%；P = 0.04）与GTR相关，而室管膜侵犯（37%对63%；P = 0.02）与GTR相关。深部白质侵犯（36.3%对63.7%；P = 0.03）与非全切除显著相关。较小的肿瘤体积也与全切除相关（P < 0.01）。进行多因素分析后，肿瘤强化边缘厚度与GTR相关，比值比为1.57（95%置信区间=1.1 - 2.23）。此外，根据EOR，强化成分的体积有显著差异，计算得到的比值比为0.95（95%置信区间=0.92 - 0.97；P < 0.01）。
结论
标准护理MRI上的影像特征可预测IDH-WT胶质母细胞瘤患者的GTR率。多因素分析后，强化边缘厚度可预测GTR。一个包含MRI上鉴别性特征和脑肿瘤体积测定法的诊断模型具有可接受的诊断性能，特异性>90%。
