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Differentiation of progressive disease from pseudoprogression using 3D PCASL and DSC perfusion MRI in patients with glioblastoma

应用 3D PCASL 和 DSC 灌注 MRI 鉴别胶质母细胞瘤患者疾病进展与假性进展

  • 影响因子:3.10
  • DOI:10.1007/s11060-020-03475-y
  • 作者列表:"Manning, Paul","Daghighi, Shadi","Rajaratnam, Matthew K.","Parthiban, Sowmya","Bahrami, Naeim","Dale, Anders M.","Bolar, Divya","Piccioni, David E.","McDonald, Carrie R.","Farid, Nikdokht
  • 发表时间:2020-04-01
Abstract

Purpose To use 3D pseudocontinuous arterial spin labeling (3D PCASL) and dynamic susceptibility contrast-enhanced (DSC) perfusion MRI to differentiate progressive disease from pseudoprogression in patients with glioblastoma (GBM). Methods Thirty-two patients with GBM who developed progressively enhancing lesions within the radiation field following resection and chemoradiation were included in this retrospective, single-institution study. The updated modified RANO criteria were used to establish progressive disease or pseudoprogression. Following 3D PCASL and DSC MR imaging, perfusion parameter estimates of cerebral blood flow (ASL-nCBF and DSC-nrCBF) and cerebral blood volume (DSC-nrCBV) were calculated. Additionally, contrast enhanced volumes were measured. Mann–Whitney U tests were used to compare groups. Linear discriminant analysis (LDA) and area under receiver operator characteristic curve (AUC) analyses were used to evaluate performance of each perfusion parameter and to determine optimal cut-off points. Results All perfusion parameter measurements were higher in patients with progressive disease (mean, 95% CI ASL-nCBF 2.48, [2.03, 2.93]; DSC-nrCBF = 2.27, [1.85, 2.69]; DSC-nrCBV = 3.51, [2.37, 4.66]) compared to pseudoprogression (mean, 95% CI ASL-nCBF 0.99, [0.47, 1.52]; DSC-nrCBF = 1.05, [0.36, 1.74]; DSC-nCBV = 1.19, [0.34, 2.05]), and findings were significant at the p < 0.0125 level (p = 0.001, 0.003, 0.002; effect size: Cohen’s d = 1.48, 1.27, and 0.92). Contrast enhanced volumes were not significantly different between groups (p > 0.447). All perfusion parameters demonstrated high AUC (0.954 for ASL-nCBF, 0.867 for DSC-nrCBF, and 0.891 for DSC-nrCBV), however, ASL-nCBF demonstrated the highest AUC and misclassified the fewest cases (N = 6). Lesions correctly classified by ASL but misclassified by DSC were located along the skull base or adjacent to large resection cavities with residual blood products, at areas of increased susceptibility. Conclusion Both 3D PCASL and DSC perfusion MRI techniques have nearly equivalent performance for the differentiation of progressive disease from pseudoprogression in patients with GBM. However, 3D PCASL is less sensitive to susceptibility artifact and may allow for improved classification in select cases.

摘要

目的应用 3D 假连续动脉自旋标记 (3D PCASL) 和动态磁敏感对比增强 (DSC) 灌注 MRI 鉴别胶质母细胞瘤 (GBM) 患者的疾病进展和假性进展。方法本回顾性、单机构研究纳入了 32 例 GBM 患者,这些患者在切除和放化疗后在放射野内出现进行性强化病变。使用更新的改良 RANO 标准确定疾病进展或假性进展。3D PCASL 和 DSC MR 成像后,计算脑血流灌注参数估计值 (ASL-nCBF 和 DSC-nrCBF) 和脑血容量 (DSC-nrCBV)。此外,测量对比剂增强体积。使用 Mann-Whitney U 检验比较各组。线性判别分析 (LDA) 和受试者操作特征曲线下面积 (AUC) 分析用于评价每个灌注参数的性能并确定最佳截点。结果所有灌注参数测量在进行性疾病患者中均较高 (平均值,95% CI asl-ncbf 2.48,[2.03,2.93]; DSC-nrcbf = 2.27,[1.85, 2.69]; DSC-nrcbv = 3.51,[2.37,4.66]) 与假性进展相比 (平均值,95% CI ASL-nCBF 0.99,[0.47,1.52]; DSC-nrcbf   =   1.05,[0.36,1.74]; DSC-ncbv = 1.19,[0.34,2.05]),结果在 p <0.0125 水平上显著 (p = 0.001,0.003,0.002; 效应量: Cohen's d = 1.48 、 1.27 和 0.92)。对比剂增强体积在组间无显著差异 (p> 0.447)。所有灌注参数均显示高 AUC (ASL-nCBF 为 0.954,DSC-nrCBF 为 0.867,DSC-nrCBV 为 0.891),然而,ASL-nCBF 显示 AUC 最高,错分病例最少 (n = 6)。病变按 ASL 正确分类,但按 DSC 错误分类,位于颅底或邻近大切除腔及残留血液制品,易感性增加的区域。结论 3D PCASL 和 DSC 灌注 MRI 技术对 GBM 患者的疾病进展和假性进展的鉴别具有几乎等效的性能。然而,3D PCASL 对易感性伪影的敏感性较低,在选定的情况下可能允许改进分类。

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影响因子:3.96
发表时间:2020-01-01
DOI:10.1002/jmri.26786
作者列表:["Bhattacharjee R","Gupta RK","Patir R","Vaishya S","Ahlawat S","Singh A"]

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