脉冲饱和转移是否足以区分脑转移瘤中的辐射坏死和肿瘤进展?

IF 3.7 Q1 CLINICAL NEUROLOGY Neuro-oncology advances Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI:10.1093/noajnl/vdae132
Rachel W Chan, Wilfred W Lam, Hanbo Chen, Leedan Murray, Beibei Zhang, Aimee Theriault, Ruby Endre, Sangkyu Moon, Patrick Liebig, Pejman J Maralani, Chia-Lin Tseng, Sten Myrehaug, Jay Detsky, Mary Jane Lim-Fat, Katrina Roberto, Daniel Djayakarsana, Bharathy Lingamoorthy, Hatef Mehrabian, Benazir Mir Khan, Arjun Sahgal, Hany Soliman, Greg J Stanisz
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引用次数: 0

摘要

背景:用于治疗脑转移瘤的立体定向放射外科手术(SRS)可提供大剂量放射线,具有极佳的局部控制效果,但也存在放射坏死(RN)的风险,很难将其与肿瘤进展(TP)区分开来。磁化转移(MT)和化学交换饱和转移(CEST)是区分脑转移瘤中辐射坏死和肿瘤进展的有效技术。以往的研究采用二维连续波(即阻断射频[RF]饱和)MT/CEST 方法。本研究的目的是研究三维脉冲饱和 MT/CEST 方法与灌注 MRI 在区分脑转移瘤 RN 和 TP 方面的应用:该研究纳入了 73 名曾接受过 SRS 或分次 SRS 治疗的患者,他们均接受了 MT/CEST MRI 扫描,这些患者出现了强化病灶,但不能确定诊断为 RN 或 TP。73 例患者中有 49 例接受了灌注 MRI 检查。临床结果由至少 6 个月的随访或病理证实(20% 的病变)确定:单变量逻辑回归结果显示,MT定量参数1/(RA-T2A)存在显著变量,RN为5.9 ± 2.7,TP为6.5 ± 2.9。MT/CEST 参数多变量逻辑回归模型的 AUC 最高,达到 75%,该模型包括 AREXAmide,0.625µT (P = .013)、AREXNOE,0.625µT (P = .008)、1/(RA-T2A) (P = .004) 和 T1 (P = .004)。灌注 rCBV 参数未达到显著性:脉冲饱和转移足以使区分脑转移瘤 RN 和 TP 的多变量 AUC 达到 75%,但与之前使用阻断射频方法的研究相比,AUC 较低。
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Is pulsed saturation transfer sufficient for differentiating radiation necrosis from tumor progression in brain metastases?

Background: Stereotactic radiosurgery (SRS) for the treatment of brain metastases delivers a high dose of radiation with excellent local control but comes with the risk of radiation necrosis (RN), which can be difficult to distinguish from tumor progression (TP). Magnetization transfer (MT) and chemical exchange saturation transfer (CEST) are promising techniques for distinguishing RN from TP in brain metastases. Previous studies used a 2D continuous-wave (ie, block radiofrequency [RF] saturation) MT/CEST approach. The purpose of this study is to investigate a 3D pulsed saturation MT/CEST approach with perfusion MRI for distinguishing RN from TP in brain metastases.

Methods: The study included 73 patients scanned with MT/CEST MRI previously treated with SRS or fractionated SRS who developed enhancing lesions with uncertain diagnoses of RN or TP. Perfusion MRI was acquired in 49 of 73 patients. Clinical outcomes were determined by at least 6 months of follow-up or via pathologic confirmation (in 20% of the lesions).

Results: Univariable logistic regression resulted in significant variables of the quantitative MT parameter 1/(RA·T2A), with 5.9 ± 2.7 for RN and 6.5 ± 2.9 for TP. The highest AUC of 75% was obtained using a multivariable logistic regression model for MT/CEST parameters, which included the CEST parameters of AREXAmide,0.625µT (P = .013), AREXNOE,0.625µT (P = .008), 1/(RA·T2A) (P = .004), and T1 (P = .004). The perfusion rCBV parameter did not reach significance.

Conclusions: Pulsed saturation transfer was sufficient for achieving a multivariable AUC of 75% for differentiating between RN and TP in brain metastases, but had lower AUCs compared to previous studies that used a block RF approach.

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