用于识别胶质母细胞瘤边界的术前液体衰减反转恢复（FLAIR）图像。

Preoperative FLAIR images for identifying glioblastoma boundaries.

作者信息

Shukir Bayan, Szivos Laszlo, Barzo Pal, Kis David

机构信息

Neurosurgery Department, Medicine Faculty, University of Szeged, Szeged, Hungary.

Basic Science Department, College of Pharmacy, University of Duhok, Kurdistan Region, Iraq.

出版信息

BMC Med Imaging. 2025 Jul 30;25(1):302. doi: 10.1186/s12880-025-01839-2.

DOI:10.1186/s12880-025-01839-2

PMID:40739201

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12309083/

Abstract

BACKGROUND

Glioblastoma is the most aggressive and rapidly growing type of central nervous system tumor. Despite advancements in imaging, no objective measurement for predicting the true extent of glioblastoma has been established. Compared with contrast-enhanced magnetic resonance imaging (MRI), fluid-attenuated inversion recovery (FLAIR) imaging is believed to be more sensitive for detecting infiltrated tumor cells. This study investigates the sensitivity and specificity of preoperative FLAIR imaging to predict glioblastoma true boundaries.

METHODS

Our study was retrospectively registered enrolling 20 high-grade glioma patients whose data from 16 patients were analyzed. For each patient, the primary tumor mask was identified on the preoperative FLAIR image covering the whole hyperintense region. Tumor cells infiltration mask was defined on follow-up MRI representing where the tumor recurred. According to automated anatomical labeling 3 (AAL3) and Johns Hopkins University, international consortium of brain mapping, diffusion tensor imaging-white matter-81 labels (JHU ICBM-DTI-81) standard atlases, standard brain was divided into cortical and subcortical regions. Sensitivity and specificity were determined counting the number of brain areas overlapped by the preoperative FLAIR tumor mask and the recurrence tumor mask.

RESULTS

The overall sensitivity and specificity was 82.6%, and 84.7%, respectively. Individually, hyperintensity on FLAIR images demonstrated high sensitivity but low specificity in some cases, while in others, the opposite pattern was observed. To validate the reliability of our method, predictive values were defined. The group average positive predictive value and negative predictive value were 50% and 96%, respectively.

CONCLUSION

Although FLAIR imaging demonstrates potential in delineating the extent of glioblastoma, its predictive value remains unclear, emphasizing the need for supplementary methodologies to enhance tumor delineation and improve clinical outcomes.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

胶质母细胞瘤是中枢神经系统肿瘤中最具侵袭性且生长迅速的类型。尽管影像学取得了进展，但尚未建立用于预测胶质母细胞瘤真实范围的客观测量方法。与对比增强磁共振成像（MRI）相比，液体衰减反转恢复（FLAIR）成像被认为在检测浸润性肿瘤细胞方面更敏感。本研究调查术前FLAIR成像预测胶质母细胞瘤真实边界的敏感性和特异性。

方法

我们的研究进行了回顾性登记，纳入20例高级别胶质瘤患者，分析了其中16例患者的数据。对于每位患者，在术前FLAIR图像上确定覆盖整个高信号区域的原发性肿瘤掩膜。肿瘤细胞浸润掩膜在随访MRI上定义，代表肿瘤复发的部位。根据自动解剖标记3（AAL3）和约翰霍普金斯大学脑图谱国际联盟的扩散张量成像 - 白质 - 81标签（JHU ICBM - DTI - 81）标准图谱，将标准脑分为皮质和皮质下区域。通过计算术前FLAIR肿瘤掩膜与复发肿瘤掩膜重叠的脑区数量来确定敏感性和特异性。