New Subependymal Enhancement After Radiation Therapy in High-Grade Glioma: Utilizing Morphological Features and DSC Perfusion MRI in Differentiate Progression and Post-Radiation Changes.

IF 3.3 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Kyu Sung Choi, Inpyeong Hwang, Chul Kee Park, Sung Hye Park, Seung Hong Choi
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引用次数: 0

Abstract

Background: The specific patterns of subependymal enhancement (SE) that frequently occur as radiation-induced changes in high-grade gliomas following radiotherapy are often overlooked. Perfusion MRI may offer a diagnostic clue.

Purpose: To distinguish between radiation-induced SE and progression in adult high-grade diffuse gliomas after standard treatment.

Study type: Retrospective.

Population: Ninety-four consecutive high-grade diffuse glioma patients (mean age, 55 ± 14 years; 54 [57.4%] males) with new SE identified in follow-up MRI after completion of surgery plus chemoradiation: progression (N = 74) vs. regression (N = 20).

Field strength/sequence: 3 T, gradient-echo dynamic susceptibility contrast-enhanced MRI, 3D gradient-echo contrast-enhanced T1-weighted imaging.

Assessment: To differentiate between radiation changes and progression in SE evaluation, multivariable logistic regression was performed using significant variables among SE appearance interval, IDH mutation, morphological features, and rCBV. Cox regression was performed to predict the tumor progression. For the added value of the rCBV, a log-rank test was conducted between the multivariable logistic regression models with and without the rCBV.

Statistical tests: Logistic regression, Cox regression, receiver operating characteristic analysis, log-rank test.

Results: 38.3% (36/94) patients had first specific SE (9.2 ± 9.5 months after surgery), which disappeared in 21.3% (20/94) after 5.8 ± 5.8 months after initial appearance on post-radiation MRI. IDH mutation, elongated, small lesions with lower rCBV tended to regress: IDH mutation, elongation, diameter, and rCBV_p95; odds ratio, 0.32, 1.92, 1.70, and 2.47, respectively. Qualitative evaluation of shape revealed that thin and curvilinear-shaped SE tended to regress, indicating a significant correlation with quantitative shape features (r = 0.31). In Cox regression, rCBV and lesion shape were significant (hazard ratio = 1.09 and 0.54, respectively). For sub-centimeter lesions, the rCBV showed added value in predicting outcomes (area under the curve, 0.873 vs. 0.836; log-rank test).

Data conclusion: Smaller, elongated lesions with lower rCBV and IDH mutation are associated with regression when differentiating radiation changes from progression in high-grade glioma with post-radiotherapy SE.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.

高级别胶质瘤放疗后出现新的髓下增强:利用形态学特征和 DSC 灌注磁共振成像区分进展期和放疗后变化
背景:放疗后高级别胶质瘤中经常出现的放射诱导的绒毛膜下强化(SE)的特殊模式常常被忽视。目的:区分成人高级别弥漫性胶质瘤在标准治疗后放射诱导的SE和进展:研究类型:回顾性:94例连续的高级别弥漫性胶质瘤患者(平均年龄为55 ± 14岁;54例[57.4%]男性)在完成手术加化疗后的随访MRI中发现了新的SE:进展期(N = 74)与消退期(N = 20):3T、梯度回波动态感性对比增强 MRI、三维梯度回波对比增强 T1 加权成像:为了在 SE 评估中区分辐射变化和进展,使用 SE 出现间隔、IDH 突变、形态特征和 rCBV 中的重要变量进行了多变量逻辑回归。采用 Cox 回归预测肿瘤进展。对于rCBV的附加值,在有rCBV和没有rCBV的多变量逻辑回归模型之间进行了对数秩检验:统计检验:逻辑回归、Cox回归、接受者操作特征分析、对数秩检验:38.3%(36/94)的患者首次出现特异性 SE(术后 9.2 ± 9.5 个月),21.3%(20/94)的患者在放疗后核磁共振首次出现特异性 SE(术后 5.8 ± 5.8 个月)后 SE 消失。IDH突变、拉长、rCBV较低的小病灶趋于消退:IDH突变、拉长、直径和rCBV_p95的几率比分别为0.32、1.92、1.70和2.47。对形状的定性评估显示,薄型和曲线型 SE 趋于消退,表明其与定量形状特征有显著相关性(r = 0.31)。在 Cox 回归中,rCBV 和病变形状具有显著性(危险比分别为 1.09 和 0.54)。对于亚厘米病变,rCBV 在预测结果方面显示出额外的价值(曲线下面积,0.873 vs. 0.836;对数秩检验):数据结论:在区分放疗后SE的高级别胶质瘤的放疗变化与进展时,rCBV较低、IDH突变较小、较长的病灶与进展相关。
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来源期刊
CiteScore
9.70
自引率
6.80%
发文量
494
审稿时长
2 months
期刊介绍: The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.
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