Senturk Yunus Emre, Canturk Enes Muhammed, Peker Ahmet, Yüzkan Sabahattin, Samancı Yavuz, Peker Selçuk
Department of Radiology, Koc University Hospital, Davutpaşa Caddesi, No 4, Istanbul, 34010, Turkey.
Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey.
J Neurooncol. 2025 May 23. doi: 10.1007/s11060-025-05054-5.
Stereotactic Radiosurgery (SRS) is an effective way of controlling the brain metastasis (BM) of lung carcinoma. This study evaluates the performance of dynamic contrast-enhanced MRI (DCE-MRI) and dynamic susceptibility contrast MRI (DSC-MRI) parameters to distinguish responders from non-responders at midterm follow-up in lung carcinoma BMs.
Twenty-six patients (mean age 62 ± 10 years) with 54 lung carcinoma BMs (NSCLC 67%, SCLC 33%) underwent SRS. The DCE-MRI and DSC-MRI were performed at baseline and repeated 4-8 weeks post-SRS to predict treatment responses at the midterm follow-up (6-12 months). Midterm outcomes were classified according to RANO-BM criteria as responders (complete response, partial response, or stable disease) or non-responders (progressive disease). Receiver operating characteristic (ROC) analyses evaluated the diagnostic accuracy of individual perfusion parameters and their combinations.
Forty lesions (74%) were responders, while 14 (26%) were non-responders. Progressive lesions showed a mean volume increase of 5.5-fold, whereas responders demonstrated a 60% mean volume reduction. Responders showed significantly lower absolute post-SRS K-trans (median 0.015 vs. 0.035 min⁻¹; p = 0.005), a higher proportional decrease in K-trans from baseline (- 27% vs. +13%; p = 0.017), and lower post-SRS Ve (p = 0.009) compared to non-responders. Absolute post-SRS K-trans had the highest individual predictive accuracy (AUC = 0.75, accuracy = 78%, sensitivity = 86%, specificity = 55%). Neither the dynamic change nor post-SRS nCBV alone predicted midterm response; however, combining post-SRS nCBV with K-trans slightly improved predictive performance (AUC = 0.76, accuracy = 79%).
Early post-SRS absolute K-trans is the best perfusion parameter for predicting midterm response in lung carcinoma BMs. DSC-MRI parameters alone offer limited predictive value.
立体定向放射外科（SRS）是控制肺癌脑转移（BM）的有效方法。本研究评估动态对比增强磁共振成像（DCE-MRI）和动态磁敏感对比磁共振成像（DSC-MRI）参数在肺癌脑转移中期随访中区分反应者与无反应者的性能。
26例（平均年龄62±10岁）患有54个肺癌脑转移灶（非小细胞肺癌占67%，小细胞肺癌占33%）的患者接受了SRS治疗。在基线时进行DCE-MRI和DSC-MRI检查，并在SRS后4-8周重复检查，以预测中期随访（6-12个月）时的治疗反应。中期结果根据RANO-BM标准分为反应者（完全缓解、部分缓解或疾病稳定）或无反应者（疾病进展）。受试者操作特征（ROC）分析评估了各个灌注参数及其组合的诊断准确性。
40个病灶（74%）为反应者，14个（26%）为无反应者。进展性病灶的平均体积增加了5.5倍，而反应者的平均体积减少了60%。与无反应者相比，反应者在SRS后的绝对Ktrans值显著更低（中位数0.015对0.035 min⁻¹；p = 0.005），Ktrans从基线的比例下降更高（-27%对+13%；p = 0.017），且SRS后的Ve更低（p = 0.009）。SRS后的绝对Ktrans具有最高的个体预测准确性（AUC = 0.75，准确性 = 78%，敏感性 = 86%，特异性 = 55%）。单独的动态变化或SRS后的nCBV均不能预测中期反应；然而，将SRS后的nCBV与Ktrans相结合可略微提高预测性能（AUC = 0.76，准确性 = 79%）。
SRS后早期的绝对Ktrans是预测肺癌脑转移中期反应的最佳灌注参数。单独的DSC-MRI参数预测价值有限。
