BACKGROUND The aim of this study was to investigate changes in structural magnetic resonance imaging (MRI) according to the RANO criteria and perfusion- and permeability related metrics derived from dynamic contrast-enhanced MRI (DCE) and dynamic susceptibility contrast MRI (DSC) during radiochemotherapy for prediction of progression and survival in glioblastoma. METHODS Twenty-three glioblastoma patients underwent biweekly structural and perfusion MRI before, during, and two weeks after a six weeks course of radiochemotherapy. Temporal trends of tumor volume and the perfusion-derived parameters cerebral blood volume (CBV) and blood flow (CBF) from DSC and DCE, in addition to contrast agent capillary transfer constant (Ktrans) from DCE, were assessed. The patients were separated in two groups by median survival and differences between the two groups explored. Clinical- and MRI metrics were investigated using univariate and multivariate survival analysis and a predictive survival index was generated. RESULTS Median survival was 19.2 months. A significant decrease in contrast-enhancing tumor size and CBV and CBF in both DCE- and DSC-derived parameters was seen during and two weeks past radiochemotherapy (p < 0.05). A 10%/30% increase in Ktrans/CBF two weeks after finishing radiochemotherapy resulted in significant shorter survival (13.9/16.8 vs. 31.5/33.1 months; p < 0.05). Multivariate analysis revealed an index using change in Ktrans and relative CBV from DSC significantly corresponding with survival time in months (r2 = 0.843; p < 0.001). CONCLUSIONS Significant temporal changes are evident during radiochemotherapy in tumor size (after two weeks) and perfusion-weighted MRI-derived parameters (after four weeks) in glioblastoma patients. While DCE-based metrics showed most promise for early survival prediction, a multiparametric combination of both DCE- and DSC-derived metrics gave additional information.

中文翻译：

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使用放化疗期间的时间灌注变化预测胶质母细胞瘤患者的生存和进展。

背景技术这项研究的目的是根据放射化学治疗过程中根据RANO标准以及动态对比增强MRI（DCE）和动态磁化率对比MRI（DSC）得出的灌注和渗透性相关指标，研究结构磁共振成像（MRI）的变化。用于预测胶质母细胞瘤的进展和生存。方法23例胶质母细胞瘤患者在放疗6周后，2周和2周后每两周进行MRI和灌注成像。除了来自DCE的造影剂毛细管转移常数（Ktrans）之外，还评估了肿瘤体积的时间趋势以及来自DSC和DCE的灌注血流参数脑血容量（CBV）和血流量（CBF）。通过中位生存期将患者分为两组，并探讨两组之间的差异。使用单变量和多变量生存分析调查临床和MRI指标，并生成预测生存指数。结果中位生存期为19.2个月。在放化疗期间和放疗后两周，在DCE和DSC衍生的参数中，增强造影剂的肿瘤大小以及CBV和CBF均显着降低（p <0.05）。放化疗结束后两周，Ktrans / CBF增加10％/ 30％，导致生存期显着缩短（13.9 / 16.8对31.5 / 33.1个月； p <0.05）。多变量分析显示，使用DSC中Ktrans和相对CBV的变化的指数显着对应于几个月的生存时间（r2 = 0.843； p <0.001）。结论在胶质母细胞瘤患者中，放疗期间肿瘤大小（两周后）和灌注加权MRI衍生参数（四周后）有明显的时间变化。尽管基于DCE的度量标准显示出对早期生存预测的最大希望，但DCE和DSC衍生的度量标准的多参数组合提供了更多信息。