Dixon Luke, Weld Alistair, Bhagawati Dolin, Patel Neekhil, Giannarou Stamatia, Grech-Sollars Matthew, Lim Adrian, Camp Sophie
Division of Surgery and Cancer, Imperial College London, London, UK.
Radiology, Imperial College NHS Trust, London, UK.
Acta Neurochir (Wien). 2025 May 6;167(1):133. doi: 10.1007/s00701-025-06535-2.
Accurate grading of gliomas is critical to guide therapy and predict prognosis. The presence of microvascular proliferation is a hallmark feature of high grade gliomas which to directly visualise traditionally requires targeted surgical biopsy of representative tissue. Superb microvascular imaging (SMI) is a novel high resolution Doppler ultrasound technique which can uniquely define the microvascular architecture of whole tumours.
We examined both qualitative and quantitative vascular features of 32 gliomas captured with SMI, analysing flow signal density, vessel number, branching points, curvature, vessel angle deviation, fractal dimension, and entropy.
High-grade gliomas exhibit significantly greater vascular complexity and disorganisation, with increased fractal dimension and entropy, correlating with known histopathological markers of aggressive angiogenesis. The integrated ROC model achieved high accuracy (AUC = 0.95).
This study leveraged SMI to provide further insights into the microvascular architecture of gliomas which is not resolvable by magnetic resonance imaging. Applying novel quantitative analysis the study demonstrated that there are quantifiable differences in vascular morphology between high grade and low-grade gliomas. This unique in vivo imaging of glioma vascularity and quantification warrants further exploration as a potential new diagnostic and prognostic tool that may support glioma management, intraoperative decision-making and informing future prognosis.
准确的胶质瘤分级对于指导治疗和预测预后至关重要。微血管增殖的存在是高级别胶质瘤的一个标志性特征，传统上要直接观察到这一特征需要对代表性组织进行靶向手术活检。超微血管成像（SMI）是一种新型高分辨率多普勒超声技术，它能够独特地描绘整个肿瘤的微血管结构。
我们检查了用SMI采集的32例胶质瘤的定性和定量血管特征，分析了血流信号密度、血管数量、分支点、曲率、血管角度偏差、分形维数和熵。
高级别胶质瘤表现出显著更高的血管复杂性和紊乱性，分形维数和熵增加，与侵袭性血管生成的已知组织病理学标志物相关。综合ROC模型具有较高的准确性（AUC = 0.95）。
本研究利用SMI对胶质瘤的微血管结构提供了进一步的见解，这是磁共振成像无法解决的问题。通过应用新的定量分析，该研究表明高级别和低级别胶质瘤之间的血管形态存在可量化的差异。这种独特的胶质瘤血管体内成像和量化作为一种潜在的新诊断和预后工具，值得进一步探索，它可能有助于胶质瘤的管理、术中决策并为未来的预后提供信息。
