Advanced diffusion MRI provides evidence for altered axonal microstructure and gradual peritumoral infiltration in GBM in comparison to brain metastases

IF 2.8 3区 医学 Q2 Medicine Clinical Neuroradiology Pub Date : 2024-04-29 DOI:10.1007/s00062-024-01416-0
U. Würtemberger, A. Rau, M. Diebold, L. Becker, M. Hohenhaus, J. Beck, P. C. Reinacher, D. Erny, M. Reisert, H. Urbach, T. Demerath
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Abstract

Purpose

In contrast to peritumoral edema in metastases, GBM is histopathologically characterized by infiltrating tumor cells within the T2 signal alterations. We hypothesized that depending on the distance from the outline of the contrast-enhancing tumor we might reveal imaging evidence of gradual peritumoral infiltration in GBM and predominantly vasogenic edema around metastases. We thus investigated the gradual change of advanced diffusion metrics with the peritumoral zone in metastases and GBM.

Methods

In 30 patients with GBM and 28 with brain metastases, peritumoral T2 hyperintensity was segmented in 33% partitions based on the total volume beginning at the enhancing tumor margin and divided into inner, middle and outer zones. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy and mean diffusivity as well as Diffusion Microstructure Imaging (DMI)-based parameters Dax-intra, Dax-extra, V‑CSF and V-intra were employed to assess group-wise differences between inner and outer zones as well as within-group gradients between the inner and outer zones.

Results

In metastases, fractional anisotropy and Dax-extra were significantly reduced in the inner zone compared to the outer zone (FA p = 0.01; Dax-extra p = 0.03). In GBM, we noted a reduced Dax-extra and significantly lower intraaxonal volume fraction (Dax-extra p = 0.008, V‑intra p = 0.006) accompanied by elevated axial intraaxonal diffusivity in the inner zone (p = 0.035). Between-group comparison of the outer to the inner zones revealed significantly higher gradients in metastases over GBM for FA (p = 0.04) as well as the axial diffusivity in the intra- (p = 0.02) and extraaxonal compartment (p < 0.001).

Conclusion

Our findings provide evidence of gradual alterations within the peritumoral zone of brain tumors. These are compatible with predominant (vasogenic) edema formation in metastases, whereas our findings in GBM are in line with an axonal destructive component in the immediate peritumoral area and evidence of tumor cell infiltration with accentuation in the tumor’s vicinity.

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与脑转移瘤相比,高级弥散核磁共振成像为 GBM 的轴突微结构改变和瘤周逐渐浸润提供了证据
目的与转移瘤的瘤周水肿不同,GBM 的组织病理学特征是 T2 信号改变内有浸润的肿瘤细胞。我们假设,根据与造影剂增强肿瘤轮廓的距离,我们可能会发现 GBM 肿瘤周围逐渐浸润的成像证据,而转移瘤周围主要是血管源性水肿。方法 在 30 例 GBM 患者和 28 例脑转移瘤患者中,根据从增强肿瘤边缘开始的总体积,将瘤周 T2 高密度划分为 33% 的区域,并分为内区、中区和外区。采用弥散张量成像(DTI)得出的分数各向异性和平均扩散率以及基于弥散微结构成像(DMI)的参数Dax-intra、Dax-extra、V-CSF和V-intra来评估内外区之间的组间差异以及内外区之间的组内梯度。结果在转移瘤中,与外区相比,内区的分数各向异性和 Dax-extra 明显降低(FA p = 0.01;Dax-extra p = 0.03)。在 GBM 中,我们注意到内区的 Dax-extra 减少,轴内体积分数明显降低(Dax-extra p = 0.008,V-intra p = 0.006),同时轴内扩散性升高(p = 0.035)。外区与内区的组间比较显示,转移瘤的 FA 梯度(p = 0.04)以及轴内(p = 0.02)和轴外(p < 0.001)的轴向扩散性均明显高于 GBM。这些变化与转移瘤的主要(血管源性)水肿形成相一致,而我们在 GBM 中的发现则与紧邻瘤周区域的轴突破坏性成分以及肿瘤细胞浸润的证据相一致,并且在肿瘤附近更为突出。
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来源期刊
Clinical Neuroradiology
Clinical Neuroradiology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
4.90
自引率
3.60%
发文量
0
期刊介绍: Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.
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