分析案例讲稿2258

CharacterisingpatternsoftumourinvasioninTimothyJLarkin1,NatalieRBoonzaier1,LailaAMohsen2,andStephenJTargetaudience:ClinicianstreatingpatientswithglioblastomaandimagingscientistsinterestedinimaginggliomaPurpose:Gliomaisthemostcommonprimarybraintumourandithasatendencytoinvadealonganddisruptwhitemattertracts.Diffusiontensorimaging(DTI)issensitivetowhitematterintegrityandinthecaseofglioma posingthediffusiontensorintoanisotropiccomponent(p)andananisotropiccomponent(q)hasbeenusedpreviouslytoinvestigatepatternsofgliomainvasion.Characterisationofdifferentinvasivephenotypesingliomaisofinterestasitmayindicateareaswhereatumourislikelytoreoccur,andadditionally,theextentofinvasioncorrelateswithprogressionsurvival1.Methods:Diffusiontensorimagingwasperformedpreoperativelyforacohortof46patientswithhigh-gradeglioma(meanage54.8years,range22-73years;male=33,female=13)at3TonaTrio.Regionsofinterest(ROIs)weredrawnaroundthepandqabnormalitiesforeachtumourbyanexperiencedneurosurgeonusingImageJ.Thepatternofinvasionwasthenclassifiedaseitherminimally(n=7),locally(n=14)ordiffusely(n=23)invasivebyvisualinspectionoftherelativeextentofthetwoabnormalitiesaccordingtopreviouslypublishedcriteria2.Theinter-raterreliabilityofassigninginvasivepatternswasassessedonasubsetof30patientsusingROIsdrawntlybyasecondexperiencedneuroradiologist.WesoughttodevelopanobjectivemethodofdefiningthedifferentinvasivephenotypesbymeasuringthedistancweentheedgesofthepandqROIsonaslicebyslicebasisintwodimensions.TheHausdorffdistancweenthecontoursdefiningtheregionsofinterestwascalculatedusing.RatherthanjustreporttheumdistancweentheROIswealsocalculatedthemedianandthe90thpercentileofthedistances.DifferencesbetweentheinvasivepatternswereexploredusingANOVAwiththeTukey-KramerHSDpost-hoctestandasignificancelevelof0.05(IBMSPSSver22).Results:Therewasagreementontheinvasivepatternbetweenthetworatersin90%ofcases,givingakappastatisticof0.81,suggestinggoodinter-raterreliability,withaconsensusbeingusedasesofdisagreement.Significantdifferenceswereobservedinthemediandistancesbetweentheedgesfortumoursthatwereminimally(2.4±0.4mm)versuslocally(4.3±2.0mm)invasive(P< DistanceDistance

90th

Figure1.Plotshowingcomparisonbetweenmedian,90thpercentileand HausdorffdistancesbetweenedgepixelsoftheofthepandqROIsfordifferentpatternsofglioblastomainvasion0.05),andbetweenminimallyanddiffusely(5.9±2.8mm)invasivetumours(P<0.01).Similarly,theumdistancweenROIswassignificantlydifferentfortheminimally(17±4mm)comparedtolocally(30±12mm)invasivetumours(P<0.05)andbetweentheminimallyanddiffusively(36±12mm)invasivetumours(P<0.05).The90thpercentileoftheHausdorffdistancewassignificantlydifferentbetweenlocally(13±5mm)anddiffusely(17±5mm)invasivetumours(P<0.05).Discussion:Theseresultsshowthatthevisuallyassignedinvasionpatternsareindeeddistt.WhilelocallyanddiffuselyinvasivetumoursdonothavesignificantlydifferentumHausdorffdistancesbyitispossibletodistinguishthemusingthefulldistancedistributionprofile.FurtherworkisunderwaytodevelopanautomatedclassifierforassigningdifferentpatternsofgliomainvasionfromDTIdata,whiayprovideprognosticinformationandidentifyareasofinvasionformoreaggressivetargetingoftherapy.Conclusion:Patternsofgliomainvasionclassifiedvisuallywereshowntobedifferentbyanobjectiveysis.MohsenLA,ShiV,JenaR,GillardJH,PriceSJDiffusiontensorinvasivephenotypescanpredictprogression-survivalinglioblastomas.BrJNeurosurg.2013;27:436-441PriceSJ,JenaR,Bu NG,CarpenterTA,PickardJD,GillardJH.Predictingpatternsofgliomarecurrenceusingdiffusiontensorimaging.Eur.Radio.2007;17:1675-1684Proc.Intl.Soc.Mag.Reson.Med.23 TimothyJLarkin1、NatalieRBoonzaier1、LailaAMohsen2和StephenJPrice1(DTI)(p)(q)方法：术前在西门子Trio上对46名高级别胶质瘤患者（平均年龄54.8岁，范围22-73岁；3313）3TImageJpqROI2，通过目视检查两种异常的相对程度，将侵袭模式分为轻微侵袭（n=7）、局部侵袭（n=14）或弥漫性侵袭（n=23）ROI，30维上逐个切片地测量p和qROI边缘之间的距离。使用计算定义感兴趣区域的轮廓之间的豪距离。我们不仅报告ROI之间的最大距离，还计算了距离的中位数和第90个百分位ANOVATukey-KramerHSD事后检验以及0.05的显着性水平(IBMSPSSver22)探90%，kappa0.81，表明评估者间的(2.40.4mm)肿瘤(4.3±2.0mm)边缘之间的中位距离观察到显着差异(P<60.0050.0040.0030.0020.0010.001pqROI90Hausdorff0.05），以及最小和弥漫性（5.92.8mm）侵袭性肿瘤之间（P0.01）(174mm)(3012mm)(P0.05(3612mm)侵袭性肿瘤之间的ROI之间的最大距离存在显着差异(P<0.05)。P<0.05