IdentifyingtheAssociationofContrastEnhancementwithVascularEndotheliaGrowthFactorExpression

• 作 者: YINYANWANG KAIWANG YANONGLI
• 机 构: 首都医科大学附属北京天坛医院
• 出 处: 中华放射学学术大会2016、中华医学会第23次全国放射学学术大会暨中华医学会第24次全国影像技术学术大会
• 发表日期: 2016年5期
• 关键词: anaplastic glioma VEGF MR outcome

　　Objective:Contrastenhancementis oneofthemajorMRcharacteristicsofhigh-gradegliomas,thispresentationgenerally indicatesthatthetumorgrewrapidlyandthatthebloodbrainbarrierwasdisrupted,whichmakethegross-totalresection difficultandleadstoanunsatisfactoryprognosis.Previousstudiessuggestedthattheradiologicalmanifestationsofthehuman gliomamightbeassociatedwiththeexpressionoftumor-specificmolecularmarkers.Nevertheless,whetherthecontrast enhancementofatumoronMRimagescorrelatestogeneticchangesinthetumorisstillunclearinpatientswithanaplastic gliomas(AG).Thepresentstudyaimedtoinvestigatetheunderlyingrelationshipamongradiologicalcontrastenhancement, vascularendotheliagrowthfactor(VEGF)expression,andsurvivaloutcomeforpatientswithAGbyperformingavolumetric analysisofstructureMRimages. Methods:Atotalof240patientswhounderwentprimarysurgicalresectionatourinstitutebetweenOctober2007andApril 2010wereretrospectivelyreviewed.TheMRdataincludedpre-surgical,post-contrastT1-wieghtedimagesandT2-weighted images.Theregionsofinterestweremanuallydelineatedbytwoexperiencedneuro-radiologists,respectively.ThevolumesofT2 hyper-intensity,contrastenhancedregionsandnecroticregionsweremeasuredandtheirratioswerecalculated.PatientswithAG wereclassifiedintotwogroupsbasedonthelevelofVEGFexpression,andthefeaturesoftumorvolumeratiosbetweenthetwo groupswerecompared.Mann-Whitneytest,Log-rankanalysis,andCoxregressionanalysiswereperformedbySPSS16.0version. Results:ThevolumetricratioofenhancementtonecrosiswassignificantlyhigherinpatientswithlowVEGFexpressionthan thosewithhighVEGFexpression(p=0.009).ThevolumetricratiosofcontrastenhancementtoT2hyper-intensity(p=0.681)and necrosistoT2hyper-intensity(p=0.277)werenotsignificantlydifferentbetweenthelowexpressiongroupandhighexpression group.Univariateanalysisshowedthatageatdiagnosis,preoperativeKPS,resectionextent,volumeratioofenhancementto necrosis,andradiotherapyweresignificantpredictorsofprogression-freesurvival(PFS)andoverallsurvival(OS)forpatientswith AG,whiletheoligodendroglialcomponentwasonlypredictiveforPFS.Inthemultivariateanalysis,age≥50,preoperativeKPS< 80,non-grosstotalresection,thevolumeratioofenhancementtonecrosis<2wereriskfactorsforPFSandOS;however,the radiotherapywasaprotectivefactorforPFSandOS. Conclusion:Itwasshowedthatthevolumetricratioofenhancementtonecrosiscouldserveasanoninvasiveradiographic predictorforsurvivaloutcomeofpatientswithAG.Inaddition,ageatdiagnosis,preoperativeKPS,extentofresection,and radiotherapywereindependentpredictorsofsurvival.