Abstract

Background

Differentiating treatment-induced injury from recurrent high-grade glioma is an ongoing challenge in neuro-oncology, in part due to lesion heterogeneity. This study aimed to determine whether different MR features were relevant for distinguishing recurrent tumor from the effects of treatment in contrast-enhancing lesions (CEL) and non-enhancing lesions (NEL).

Methods

This prospective study analyzed 291 tissue samples (222 recurrent tumor, 69 treatment-effect) with known coordinates on imaging from 139 patients who underwent preoperative 3T MRI and surgery for a suspected recurrence. 8 MR parameter values were tested from perfusion-weighted, diffusion-weighted, and MR spectroscopic imaging at each tissue sample location for association with histopathological outcome using generalized estimating equation models for CEL and NEL tissue samples. Individual cutoff values were evaluated using receiver operating characteristic curve analysis with 5-fold cross-validation.

Results

In tissue samples obtained from CEL, elevated relative cerebral blood volume (rCBV) was associated with the presence of recurrent tumor pathology (P < 0.03), while increases in normalized choline (nCho) and choline-to-NAA index (CNI) were associated with the presence of recurrent tumor pathology in NEL tissue samples (P < 0.008). A mean CNI cutoff value of 2.7 had the highest performance, resulting in mean sensitivity and specificity of 0.61 and 0.81 for distinguishing treatment-effect from recurrent tumor within the NEL.

Conclusion

Although our results support prior work that underscores the utility of rCBV in distinguishing the effects of treatment from recurrent tumor within the contrast enhancing lesion, we found that metabolic parameters may be better at differentiating recurrent tumor from treatment-related changes in the NEL of high-grade gliomas.

中文翻译：

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复发性肿瘤和治疗诱导的效应在高级别胶质瘤的对比增强和非增强病变中具有不同的 MR 特征。

摘要

背景

将治疗引起的损伤与复发性高级别胶质瘤区分开来是神经肿瘤学中的一个持续挑战，部分原因是病变的异质性。本研究旨在确定不同的 MR 特征是否与区分复发性肿瘤与对比增强病变 (CEL) 和非增强病变 (NEL) 的治疗效果相关。

方法

这项前瞻性研究分析了 139 名接受术前 3T MRI 和疑似复发手术的患者的 291 个组织样本（222 个复发肿瘤，69 个治疗效果），其影像学坐标已知。使用 CEL 和 NEL 组织样本的广义估计方程模型，从每个组织样本位置的灌注加权、扩散加权和 MR 光谱成像测试了 8 个 MR 参数值与组织病理学结果的关联。使用具有 5 倍交叉验证的接收器操作特征曲线分析评估各个截止值。

结果

在从 CEL 获得的组织样本中，相对脑血容量 (rCBV) 升高与复发性肿瘤病理相关 ( P < 0.03)，而归一化胆碱 (nCho) 和胆碱与 NAA 指数 (CNI) 的增加相关NEL 组织样本中存在复发性肿瘤病理（P < 0.008）。平均 CNI 截止值 2.7 具有最高性能，导致在 NEL 内区分治疗效果与复发性肿瘤的平均敏感性和特异性分别为 0.61 和 0.81。

结论

尽管我们的结果支持先前的工作，强调 rCBV 在区分对比增强病变内的治疗效果和复发性肿瘤方面的效用，但我们发现代谢参数可能更好地区分复发性肿瘤和高 NEL 的治疗相关变化。级胶质瘤。