文章：

流体抑制酰胺质子转移加权成像在区分脑转移瘤进展与放射性坏死方面优于泄漏校正动态磁敏感对比灌注成像

Fluid-Suppressed Amide Proton Transfer-Weighted Imaging Outperforms Leakage-Corrected Dynamic Susceptibility Contrast Perfusion in Distinguishing Progression from Radionecrosis in Brain Metastases

原文发布日期：31 March 2025

DOI: 10.3390/cancers17071175

类型: Article

开放获取: 是

英文摘要：

Background:Differentiating brain radionecrosis (RN) from tumor progression (TP) is a persistent clinical difficulty. Here, we compared the diagnostic accuracy of leakage-corrected relative cerebral blood volume (rCBV) and fluid-suppressed amide proton transfer-weighted (APTw) imaging in distinguishing between RN and TP in metastases.Methods:Subjects with enlarging lesions after stereotactic radiosurgery were prospectively examined at 3T. APTw data were acquired with a 3D snapshot-gradient echo sequence. B0 and B1 inhomogeneities were corrected using the WASAB1 protocol. rCBV was calculated according to established guidelines. Image analysis was performed using Olea Sphere 3.0 software. ΔAPTw and ΔrCBV were calculated as the average signal within the lesion normalized against the average signal in the contralateral white matter. A diagnosis of TP or RN was assessed by histology or imaging at follow-up. Independent samplest-tests of ΔAPTw and ΔrCBV and the areas under the curve (AUCs) were computed.Results:Twenty-one metastases (10 RN, 11 TP) were evaluated. APTw differentiated between RN and TP (U = 120,p< 0.001), in contrast to rCBV (U = 71,p= 0.174). The AUC was 0.991 (95% CI = 0.962–1.020) for ΔAPTw, and 0.636 (95% CI = 0.352–0.921) for ΔrCBV. The optimal cutoff points were 0.4 and 2.1 for ΔAPTw and ΔrCBV, respectively. The sensitivity and specificity for RN-TP were 100% and 90% for ΔAPTw and 63.6% and 36.4% for ΔrCBV.Conclusions:Fluid-suppressed APTw metrics enabled more accurate diagnostic performances than leakage-corrected rCBV metrics in distinguishing between RN and TP. These promising results suggest that APTw imaging could valuably complement current multiparametric MRI protocols in brain metastases follow-ups.

摘要翻译： 

背景：区分脑放射性坏死（RN）与肿瘤进展（TP）是临床持续面临的难题。本研究旨在比较渗漏校正相对脑血容量（rCBV）与液体抑制酰胺质子转移加权（APTw）成像在鉴别转移瘤RN与TP中的诊断准确性。 方法：对立体定向放射外科治疗后病灶增大的受试者前瞻性进行3T磁共振检查。APTw数据采用三维快速梯度回波序列采集，并使用WASAB1协议校正B0和B1场不均匀性。rCBV依据现行指南计算。图像分析采用Olea Sphere 3.0软件。ΔAPTw和ΔrCBV计算为病灶内平均信号与对侧白质平均信号的比值。TP或RN的诊断通过组织病理学或随访影像学评估。对ΔAPTw和ΔrCBV进行独立样本t检验并计算曲线下面积（AUC）。 结果：共评估21个转移灶（10个RN，11个TP）。APTw能有效区分RN与TP（U=120，p<0.001），而rCBV则无显著差异（U=71，p=0.174）。ΔAPTw的AUC为0.991（95% CI=0.962-1.020），ΔrCBV为0.636（95% CI=0.352-0.921）。ΔAPTw和ΔrCBV的最佳截断值分别为0.4和2.1。ΔAPTw鉴别RN-TP的敏感性和特异性分别为100%和90%，ΔrCBV为63.6%和36.4%。 结论：在区分RN与TP方面，液体抑制APTw指标比渗漏校正rCBV指标具有更准确的诊断性能。这些积极结果表明，APTw成像可作为脑转移瘤随访中现有多参数MRI方案的有价值补充。

原文链接：

Fluid-Suppressed Amide Proton Transfer-Weighted Imaging Outperforms Leakage-Corrected Dynamic Susceptibility Contrast Perfusion in Distinguishing Progression from Radionecrosis in Brain Metastases