FLAIR MRI 的参数响应映射提供了胶质母细胞瘤进展风险的早期指示,Academic Radiology

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FLAIR MRI 的参数响应映射提供了胶质母细胞瘤进展风险的早期指示
Academic Radiology ( IF 3.8 ) Pub Date : 2020-09-11 , DOI: 10.1016/j.acra.2020.08.015
Benjamin A Hoff ₁ , Benjamin Lemasson ₂ , Thomas L Chenevert ₁ , Gary D Luker ₁ , Christina I Tsien ₃ , Ghoncheh Amouzandeh ₁ , Timothy D Johnson ₄ , Brian D Ross ₁

Affiliation

理由和目标

胶质母细胞瘤图像评估利用磁共振成像对比增强、T1 加权和非对比 T2 加权流体衰减反转恢复 (FLAIR) 采集。疾病进展评估依赖于肿瘤直径的变化，这与生存相关性很差。为了改进胶质母细胞瘤的治疗监测，我们调查了解剖学对齐的 FLAIR 信号的连续体素比较，作为 GBM 进展的早期预测因子。

材料和方法

我们使用体素参数响应映射 (PRM) 分析了 52 名受试者的纵向归一化 FLAIR 图像 (rFLAIR)，以监测增加 (PRM _rFLAIR+ )、减少 (PRM _rFLAIR- ) 或不变 (PRM _rFLAIR0 ) rFLAIR 强度的体积分数。我们通过 rFLAIR 确定了治疗前和治疗后 10 周之间的反应。根据神经肿瘤学反应评估 (RANO) 标准定义的疾病稳定或部分反应的受试者子集 (N = 26) 的疾病进展风险由 PRM _rFLAIR在第 10 周和第 20 周之间评估，并持续评估直到 PRM _rFLAIR+超过定义的阈值。将 RANO 定义的标准与 PRM 衍生的肿瘤进展检测结果进行比较。

结果

使用 RANO 标准（PFS：p <0.0001；OS：p <0.0001）、FLAIR-高信号体积的相对变化（PFS：p  = 0.0011；OS：p <0.0001）和 PRM _rFLAIR+（PFS：p <0.01；OS：p <0.001）。PRM _rFLAIR+还在第 10 周和第 20 周之间对有反应的患者的进展进行分层（PFS：p <0.05；OS：p  = 0.01），而 FLAIR 体积测量值的变化不是预测性的。作为持续评估，PRM _rFLAIR+超过 10% 的患者在 5.6 个月后进行 PFA 分层 ( p <0.0001)，而 RANO 标准直到 15.4 个月才对患者进行分层 ( p <0.0001)。

结论

PRM _rFLAIR可以提供胶质母细胞瘤疾病进展的早期生物标志物。

"点击查看英文标题和摘要"

Parametric Response Mapping of FLAIR MRI Provides an Early Indication of Progression Risk in Glioblastoma

Rationale and Objectives

Glioblastoma image evaluation utilizes Magnetic Resonance Imaging contrast-enhanced, T1-weighted, and noncontrast T2-weighted fluid-attenuated inversion recovery (FLAIR) acquisitions. Disease progression assessment relies on changes in tumor diameter, which correlate poorly with survival. To improve treatment monitoring in glioblastoma, we investigated serial voxel-wise comparison of anatomically-aligned FLAIR signal as an early predictor of GBM progression.

Materials and Methods

We analyzed longitudinal normalized FLAIR images (rFLAIR) from 52 subjects using voxel-wise Parametric Response Mapping (PRM) to monitor volume fractions of increased (PRM_rFLAIR+), decreased (PRM_rFLAIR-), or unchanged (PRM_rFLAIR0) rFLAIR intensity. We determined response by rFLAIR between pretreatment and 10 weeks posttreatment. Risk of disease progression in a subset of subjects (N = 26) with stable disease or partial response as defined by Response Assessment in Neuro-Oncology (RANO) criteria was assessed by PRM_rFLAIR between weeks 10 and 20 and continuously until the PRM_rFLAIR+ exceeded a defined threshold. RANO defined criteria were compared with PRM-derived outcomes for tumor progression detection.

Results

Patient stratification for progression-free survival (PFS) and overall survival (OS) was achieved at week 10 using RANO criteria (PFS: p <0.0001; OS: p <0.0001), relative change in FLAIR-hyperintense volume (PFS: p = 0.0011; OS: p <0.0001), and PRM_rFLAIR+ (PFS: p <0.01; OS: p <0.001). PRM_rFLAIR+ also stratified responding patients’ progression between weeks 10 and 20 (PFS: p <0.05; OS: p = 0.01) while changes in FLAIR-volume measurements were not predictive. As a continuous evaluation, PRM_rFLAIR+ exceeding 10% stratified patients for PFA after 5.6 months (p<0.0001), while RANO criteria did not stratify patients until 15.4 months (p <0.0001).