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Radiology:这一影像学技术,可陪伴胶质母细胞瘤患者共同前进!

2021-05-08 shaosai MedSci原创

胶质母细胞瘤的典型特征是血管内皮生长因子介导的血管生成,因此临床上对该蛋白的靶向治疗产生了极大兴趣。

胶质母细胞瘤的典型特征是血管内皮生长因子介导的血管生成,因此临床上对该蛋白的靶向治疗产生了极大兴趣。尽管靶向血管内皮生长因子的抗血管生成药物(如贝伐珠单抗)已越来越多地用于复发性胶质母细胞瘤,但由于抗血管生成治疗对肿瘤血管系统的独特影响,应用影像学指标及特征精确定量抗血管生成治疗的反应仍具有挑战性。

对复发性胶质母细胞瘤患者的临床研究表明,扩散加权成像(DWI)有助于在应用贝伐珠单抗治疗前对患者进行分层,低表观扩散系数(ADC)与较短的无进展生存期(PFS)相关。然而,治疗后ADC值的下降不仅包括细胞死亡,还包括由于渗透性降低、慢性缺氧和凝固性坏死导致的相应布朗运用改变,进而影响对治疗结果的判断。多项研究表明,酰胺质子转移(APT)MRI可显示出在组织病理学相关方面具有高细胞性和增殖性的肿瘤活跃部分。

近日,发表在Radiology杂志的一项研究探讨了抗血管生成治疗后APT信号强度的变化是否能预测复发性胶质母细胞瘤的早期治疗反应,为临床建立了一个评估抗血管生成治疗反应的新的、可靠的影像学指标,解决了临床改善疾病治疗流程的主要需求。

本研究对2015年7月至2019年4月期间的复发性胶质母细胞瘤患者进行了评估,每位患者均在治疗前及贝伐珠单抗使用后4-6周(随访)接受了APT、DWI和DSC MRI扫描。进展基于病理证实或临床影像学评估,进展模式定义为局部强化或弥漫性不强化。计算APT信号强度平均值和直方图参数(第5百分位和第95百分位)、表观扩散系数和标准化脑血容量(CBV)在成像时间点之间的变化。采用logistic回归和Cox比例风险模型,根据进展类型确定12个月进展和无进展生存(PFS)的预测因子。

本研究共纳入54例患者(中位年龄56岁[四分位数范围49-64岁];24人)。贝伐珠单抗治疗后的平均APT信号强度变化代表了12个月的低进展率(优势比[OR],0.36;95%置信区间[CI]: 0.13, 0.90;P = .04)和更长的PFS(OR:0.38;95% CI: 0.20, 0.74;P = 04)。随访时高平均标准化CBV与较高的12个月进展率(OR, 20;95% CI:2.7,32;P = .04)和较短的PFS(OR,9.4;95% CI: 2.3, 38;P = .002)相关平均APT信号强度变化是弥漫性非增强进展模式的显著预测因子(OR, 0.27;95% CI: 0.06, 0.85;P = 0.047),而随访标准化CBV的第95百分位是局部强化进展模式的预测因子(OR, 7.1;95% CI: 2.4, 15;P = .04点)。

图1 该图显示了基于平均酰胺质子转移(APT)信号强度变化的贝伐珠单抗治疗前后的无进展生存(PFS) Kaplan-Meier评估。

表 接受贝伐珠单抗治疗患者的12个月进展和无进展生存期分层的影像学参数。

本研究表明,在贝伐珠单抗治疗开始后4-6周,酰胺质子转移(APT) MRI信号强度的大幅降低与复发性胶质母细胞瘤患者12个月随访时治疗反应良好和更长的无进展生存期相关。APT信号强度的降低是弥漫性非强化进展模式的预测指标,而随访时高标准化脑血容量是局部强化进展模式的预测指标。本研究为临床早期、准确评估胶质母细胞瘤治疗反应提供了新的参考依据,为进一步的前瞻性研究铺平了道路。

原文出处:

Ji Eun Park,Ho Sung Kim,Seo Young Park,et al.Identification of Early Response to Anti-Angiogenic Therapy in Recurrent Glioblastoma: Amide Proton Transfer-weighted and Perfusion-weighted MRI compared with Diffusion-weighted MRI.DOI:10.1148/radiol.2020191376

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    2021-05-19 好孩子来做客了

    0

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    2021-05-10 tmxklee

    Apt临床应用不多。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1772385, encodeId=1c791e72385f4, content=<a href='/topic/show?id=c38963544cc' target=_blank style='color:#2F92EE;'>#母细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63544, encryptionId=c38963544cc, topicName=母细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b07438375157, createdName=huperzia, createdTime=Wed Jan 05 17:14:17 CST 2022, time=2022-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2052945, encodeId=50e12052945f6, content=<a href='/topic/show?id=ae848406335' target=_blank style='color:#2F92EE;'>#胶质母细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84063, encryptionId=ae848406335, topicName=胶质母细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Sun Jan 30 13:14:17 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966923, encodeId=fb88966923fd, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMZKibeag7o3hLJ6KX55VNia9OPRibmjMeTym3vr2sr9KAnZ5H4I4wbfYgR3pgLx59N3HGmg38wLoMEFIVJ5QicD9FLW/0, createdBy=96542068604, createdName=好孩子来做客了, createdTime=Wed May 19 16:20:56 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=964186, encodeId=c677964186a6, content=Apt临床应用不多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJLF28eicSRrKPBdkzgAZP7CEVCQnUicNOjA4IzJNMfwSok3udkUzy0JPnnYaicpJSnY457z98wDfsZQ/132, createdBy=7b842288156, createdName=tmxklee, createdTime=Mon May 10 08:05:12 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1476123, encodeId=f60a14e6123b5, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf5e7252474, createdName=spoonycyy, createdTime=Mon May 10 02:14:17 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963970, encodeId=4ed59639e0f4, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65d55484096, createdName=汉水人家, createdTime=Sun May 09 13:26:20 CST 2021, time=2021-05-09, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1772385, encodeId=1c791e72385f4, content=<a href='/topic/show?id=c38963544cc' target=_blank style='color:#2F92EE;'>#母细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63544, encryptionId=c38963544cc, topicName=母细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b07438375157, createdName=huperzia, createdTime=Wed Jan 05 17:14:17 CST 2022, time=2022-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2052945, encodeId=50e12052945f6, content=<a href='/topic/show?id=ae848406335' target=_blank style='color:#2F92EE;'>#胶质母细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84063, encryptionId=ae848406335, topicName=胶质母细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a691420, createdName=30397604, createdTime=Sun Jan 30 13:14:17 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966923, encodeId=fb88966923fd, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMZKibeag7o3hLJ6KX55VNia9OPRibmjMeTym3vr2sr9KAnZ5H4I4wbfYgR3pgLx59N3HGmg38wLoMEFIVJ5QicD9FLW/0, createdBy=96542068604, createdName=好孩子来做客了, createdTime=Wed May 19 16:20:56 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=964186, encodeId=c677964186a6, content=Apt临床应用不多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJLF28eicSRrKPBdkzgAZP7CEVCQnUicNOjA4IzJNMfwSok3udkUzy0JPnnYaicpJSnY457z98wDfsZQ/132, createdBy=7b842288156, createdName=tmxklee, createdTime=Mon May 10 08:05:12 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1476123, encodeId=f60a14e6123b5, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf5e7252474, createdName=spoonycyy, createdTime=Mon May 10 02:14:17 CST 2021, time=2021-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963970, encodeId=4ed59639e0f4, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65d55484096, createdName=汉水人家, createdTime=Sun May 09 13:26:20 CST 2021, time=2021-05-09, status=1, ipAttribution=)]
    2021-05-09 汉水人家

    学习学习

    0

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