Background

Quantitative diffusion-weighted imaging (DWI) probes into tissue microstructure in solid tumours. In this retrospective ethically approved study, we investigated DWI as a potential non-invasive predictor of tumour dignity and prognosis in paediatric patients with neuroblastic tumours.

Methods

Nineteen consecutive patients with neuroblastoma (NB, n = 15), ganglioneuroblastoma (GNB, n = 1) and ganglioneuroma (GN, n = 3) underwent 3-T magnetic resonance imaging at first diagnosis and after 3-month follow-up, following a protocol including DWI (b = 50 and 800 s/mm²) in addition to standard sequences. All DWI scans were analysed for tumour volume assessment and apparent diffusion coefficient (ADC) calculation. Correlation with tumour pathology and risk factors (bone-marrow metastases, MYCN-amplification and 1p-deletion), therapeutic regime (observation versus chemotherapy) and clinical follow-up was evaluated.

Results

At baseline, mean ADC in NB was lower than in GNB/GN (0.76 vs. 1.47 × 10⁻³ mm²/s, p = 0.003). An ADC cutoff ≤ 1.05 identified malignant disease with 100.0% sensitivity (95% confidence interval [CI] 29.2–100.0%) and 93.8% specificity (95% CI 69.8–99.8%). Initial ADC was < 0.80 in all NB patients with eventual tumour relapse. During follow-up, tumour ADC values increased in the observation group (NB/GN) without relapse (p = 0.043). In eventually relapsing tumours, ADC values at follow-up tended to decrease further despite reduction in tumour volume.

Conclusions

ADC values at first presentation differed significantly between malignant and benign neuroblastic tumours. Low baseline ADC was predictive of tumour progression and relapse in NB patients. With therapy, increasing ADC values appeared to predict relapse-free survival, while a decreasing ADC during therapy was an indicator of poor prognosis.

中文翻译：

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定量DWI可以预测神经母细胞瘤患儿的无事件生存：一项回顾性队列研究的初步发现。

背景

定量扩散加权成像（DWI）探查实体瘤中的组织微观结构。在这项经伦理学批准的回顾性研究中，我们调查了DWI作为小儿神经母细胞瘤患者肿瘤尊严和预后的潜在非侵入性预测因子。

方法

连续19例神经母细胞瘤（NB，n  = 15），神经节神经母细胞瘤（GNB，n  = 1）和神经节神经瘤（GN，n  = 3）患者在初诊时和随后3个月的随访中接受了3T磁共振成像除标准序列外，还包括DWI（b  = 50和800 s / mm ²）的协议。分析所有DWI扫描以进行肿瘤体积评估和表观扩散系数（ADC）计算。评估与肿瘤病理学和危险因素（骨髓转移，MYCN扩增和1p缺失），治疗方案（观察与化疗）和临床随访的相关性。

结果

在基线时，NB中的平均ADC低于GNB / GN中的平均ADC（0.76对1.47×10 ^-3  mm ² / s，p  = 0.003）。ADC截止值≤1.05可以确定具有100.0％的敏感性（95％置信区间[CI] 29.2–100.0％）和93.8％的特异性（95％CI 69.8–99.8％）的恶性疾病。在所有最终肿瘤复发的NB患者中，初始ADC <0.80。在随访期间，观察组（NB / GN）的肿瘤ADC值增加，且未复发（p  = 0.043）。在最终复发的肿瘤中，尽管肿瘤体积减小，但随访时的ADC值趋于进一步降低。

结论

初次出现的ADC值在恶性和良性神经母细胞瘤之间存在显着差异。低基线ADC可预测NB患者的肿瘤进展和复发。通过治疗，增加ADC值似乎可以预测无复发生存，而在治疗期间降低ADC是预后不良的指标。