PDF(Pubmed)
Abstract：
Distinguishing treatment-related abnormalities (TRA) from tumor progression (TP) in glioblastoma patients is a diagnostic imaging challenge due to the identical morphology of conventional MR imaging sequences. Diffusion-weighted imaging (DWI) and its derived images of the apparent diffusion coefficient (ADC) have been suggested as diagnostic tools for this problem. The aim of this study is to determine the diagnostic accuracy of different cut-off values of the ADC to differentiate between TP and TRA. In total, 76 post-treatment glioblastoma patients with new contrast-enhancing lesions were selected. Lesions were segmented using a T1-weighted, contrast-enhanced scan. The mean ADC values of the segmentations were compared between TRA and TP groups. Diagnostic accuracy was compared by use of the area under the curve (AUC) and the derived sensitivity and specificity values from cutoff points. Although ADC values in TP (mean = 1.32 × 10-3 mm2/s; SD = 0.31 × 10-3 mm2/s) were significantly different compared to TRA (mean = 1.53 × 10-3 mm2/s; SD = 0.28 × 10-3 mm2/s) (p = 0.003), considerable overlap in their distributions exists. The AUC of ADC values to distinguish TP from TRA was 0.71, with a sensitivity and specificity of 65% and 70%, respectively, at an ADC value of 1.47 × 10-3 mm2/s. These findings therefore indicate that ADC maps should not be used in discerning between TP and TRA at a certain timepoint without information on temporal evolution.
摘要：
由于常规MR成像序列的形态相同，将胶质母细胞瘤患者的治疗相关异常（TRA）与肿瘤进展（TP）区分开来是一种诊断性成像挑战。扩散加权成像（DWI）及其导出的表观扩散系数（ADC）图像已被建议作为该问题的诊断工具。这项研究的目的是确定ADC的不同截止值的诊断准确性，以区分TP和TRA。总的来说,选择76例具有新的对比增强病变的治疗后胶质母细胞瘤患者。病变使用T1加权，对比增强扫描。比较TRA和TP组之间分段的平均ADC值。通过使用曲线下面积(AUC)和从截止点导出的灵敏度和特异性值来比较诊断准确性。尽管TP中的ADC值（平均值=1.32×10-3mm2/s；SD=0.31×10-3mm2/s）与TRA（平均值=1.53×10-3mm2/s；SD=0.28×10-3mm2/s）（p=0.003）相比有显着差异，它们的分布存在相当大的重叠。ADC值区分TP和TRA的AUC为0.71，敏感性和特异性分别为65%和70%，分别,ADC值为1.47×10-3mm2/s。因此，这些发现表明，在没有时间演变信息的情况下，不应在某个时间点使用ADC图辨别TP和TRA。
