摘要
目的通过动态磁敏感对比增强灌注加权成像(dynamic susceptibility contrast-enhanced perfusion weighted imaging,DSC-PWI)和弥散加权成像(diffusion weighted imaging,DWI)构建肿瘤生境,探讨各生境中的相对脑血容量中值(median relative cerebral blood volume,rCBVmedian)预测胶质母细胞瘤(glioblastoma,GBM)患者总生存期(overall survival,OS)的价值。方法采用回顾性队列研究设计,收集陆军特色医学中心2016-2021年经手术病理证实的58例GBM患者的相关资料,所有患者术前1周内行常规MRI、DSC-PWI及DWI检查。采用深度学习模型nnU-Net和K均值聚类算法(K-means)构建传统肿瘤生境(traditional habitat,TH)、血流灌注相关生境(vascular habitat 1~4,VH1~4)及联合生境(combined habitat 1~6,CH1~6)。运用Spearman相关分析判断各个生境的rCBVmedian值与GBM患者OS的相关性,根据各个生境的rCBVmedian中位数将患者分为高、低rCBVmedian组,采用Kaplan-Merier法绘制高rCBVmedian组与低rCBVmedian组的生存曲线,并行Log-rank检验,采用Cox回归分析评估GBM患者OS的独立危险因素。结果在CH1及VH1生境中,rCBVmedian值与GBM患者OS的相关性相对于其他生境而言较强(r=-0.404、-0.398,P=0.002);在Whole ET、VH1及CH1生境中,根据rCBVmedian值转换为二分类变量显示,患者两组OS差异有统计学意义(P<0.05);VH1及CH1生境的rCBVmedian值是影响GBM患者预后的独立危险因素(P<0.05)。结论代表新生血管高度增殖的VH1生境与代表肿瘤细胞增殖活跃的CH1生境中获取的rCBVmedian值可能是预测GBM患者术后总生存期的有意义指标。
Objective To determine the predictive value of median relative cerebral blood volume(rCBVmedian)of each habitat of glioblastoma(GBM)for overall survival(OS)by using multi-parametric MR habitat imaging analysis constructed by dynamic susceptibility contrast-enhanced perfusion weighted imaging(DSC-PWI)and diffusion weighted imaging(DWI).MethodsA retrospective cohort trial was conducted on 58 patients with pathology-diagnosed GBM in Army Medical Center of PLA from January 2016 to December 2021.All patients underwent routine MRI,DSC-PWI and DWI examination within 1 week before surgery.Deep learning-based nnU-Net model and K-means clustering algorithm were applied to construct traditional habitat(TH),vascular habitat 1~4(VH1~4),and their combined habitat 1~6(CH1~6).Spearman correlation analysis was used to determine the correlation between rCBVmedian value and OS of the GBM patients in different habitats.Kaplan-Merier survival curve was plotted for rCBVmedian-high group and rCBVmedian-low group according to their rCBVmedian value,and the difference was showed by Log-rank test.Cox analysis was performed to predict independent risk factors for OS.ResultsThe correlation between rCBVmedian value and OS in GBM patients was stronger in CH1 and VHI than in other habitats(r=-0.404、-0.398,P=0.002).In the Whole ET,VH1 and CH1 habitats,the conversion of rCBVmedian into binary variables showed significant differences in OS between the 2 groups(P<0.05).The rCBVmedian values of VH1 and CH1 habitats were independent risk factors for the prognosis of GBM patients(P<0.05).ConclusionThe rCBVmedian values,obtained from VH1 representing the high angiogenic-enhancing tumor habitat,and from CH1 representing the area with active tumor cell proliferation,may be significant indicators for predicting the overall postoperative survival of GBM patients.
作者
刘嘉晨
丛超
郭虹
吴昊
冉启胜
康厚艺
方靖琴
张伟国
LIU Jiachen;CONG Chao;GUO Hong;WU Hao;RAN Qisheng;KANG Houyi;FANG Jingqin;ZHANG Weiguo(Department of Radiology,Army Medical Center of PLA,Chongqing,400042;Department of Nuclear Medicine,Army Medical Center of PLA,Chongqing,400042;Chongqing Clinical Research Center for Imaging and Nuclear Medicine,Chongqing,400042;School of Electrical and Electronic Engineering,Chongqing University of Technology,Chongqing,400054,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2023年第12期1301-1310,共10页
Journal of Army Medical University
基金
重庆市影像医学与核医学临床研究中心科技计划(CSTC2015YFPT-gcjsyjzx0175)
陆军特色医学中心医务人员创新能力提升计划(2019CXLCC019)。