Nichelli Lucia, Casagranda Stefano, Dipasquale Ottavia, Bensemain Mehdi, Papageorgakis Christos, Zucchelli Mauro, Jacob Julian, Valery Charles, Mathon Bertrand, Liebig Patrick, Zaiss Moritz, Lehéricy Stéphane
Paris Brain Institute (PBI)-Institut du Cerveau (ICM), Sorbonne University, Inserm UMR S 1127, CNRS 7225, F-75013 Paris, France.
Department of Neuroradiology, La Pitié Salpêtrière Hospital, AP-HP Sorbonne University, F-75013 Paris, France.
Cancers (Basel). 2025 Mar 31;17(7):1175. doi: 10.3390/cancers17071175.
Differentiating brain radionecrosis (RN) from tumor progression (TP) is a persistent clinical difficulty. Here, we compared the diagnostic accuracy of leakage-corrected relative cerebral blood volume (rCBV) and fluid-suppressed amide proton transfer-weighted (APTw) imaging in distinguishing between RN and TP in metastases. Subjects with enlarging lesions after stereotactic radiosurgery were prospectively examined at 3T. APTw data were acquired with a 3D snapshot-gradient echo sequence. B0 and B1 inhomogeneities were corrected using the WASAB1 protocol. rCBV was calculated according to established guidelines. Image analysis was performed using Olea Sphere 3.0 software. ΔAPTw and ΔrCBV were calculated as the average signal within the lesion normalized against the average signal in the contralateral white matter. A diagnosis of TP or RN was assessed by histology or imaging at follow-up. Independent samples -tests of ΔAPTw and ΔrCBV and the areas under the curve (AUCs) were computed. Twenty-one metastases (10 RN, 11 TP) were evaluated. APTw differentiated between RN and TP (U = 120, < 0.001), in contrast to rCBV (U = 71, = 0.174). The AUC was 0.991 (95% CI = 0.962-1.020) for ΔAPTw, and 0.636 (95% CI = 0.352-0.921) for ΔrCBV. The optimal cutoff points were 0.4 and 2.1 for ΔAPTw and ΔrCBV, respectively. The sensitivity and specificity for RN-TP were 100% and 90% for ΔAPTw and 63.6% and 36.4% for ΔrCBV. Fluid-suppressed APTw metrics enabled more accurate diagnostic performances than leakage-corrected rCBV metrics in distinguishing between RN and TP. These promising results suggest that APTw imaging could valuably complement current multiparametric MRI protocols in brain metastases follow-ups.
鉴别脑放射性坏死（RN）与肿瘤进展（TP）一直是临床难题。在此，我们比较了渗漏校正相对脑血容量（rCBV）和液体抑制酰胺质子转移加权（APTw）成像在鉴别转移性肿瘤中RN和TP的诊断准确性。对立体定向放射外科治疗后病灶增大的患者在3T条件下进行前瞻性检查。采用3D快照梯度回波序列采集APTw数据。使用WASAB1协议校正B0和B1不均匀性。根据既定指南计算rCBV。使用Olea Sphere 3.0软件进行图像分析。将ΔAPTw和ΔrCBV计算为病灶内平均信号相对于对侧白质平均信号的归一化值。通过随访时的组织学或影像学评估TP或RN的诊断。计算ΔAPTw和ΔrCBV的独立样本检验以及曲线下面积（AUC）。评估了21个转移瘤（10个RN，11个TP）。与rCBV（U = 71，P = 0.174）相比，APTw能够区分RN和TP（U = 120，P < 0.001）。ΔAPTw的AUC为0.991（95%CI = 0.962 - 1.020），ΔrCBV的AUC为0.636（95%CI = 0.352 - 0.921）。ΔAPTw和ΔrCBV的最佳截断点分别为0.4和2.1。对于RN - TP，ΔAPTw的敏感性和特异性分别为100%和90%，ΔrCBV的敏感性和特异性分别为63.6%和36.4%。在鉴别RN和TP方面，液体抑制APTw指标比渗漏校正rCBV指标具有更准确的诊断性能。这些有前景的结果表明，APTw成像在脑转移瘤随访中可有效补充当前的多参数MRI方案。
