A Preliminary Study Of Morphology MRI And DWI In Evaluating The Progression And Prognosis Of Patients With High-grade Gliomas

Part 1 A preliminary study of signal intensity in FLAIR sequences in the resection cavity can predict progression and progression-free survival in high-grade gliomasObjective:The purpose of this study is to investigate the value of the signal intensity in FLAIR sequences in the resection cavity in predicting the progression and progression free survival?PFS?in patients with high-grade gliomas?HGG?.Methods:Retrospective analysis the MR data of pathology confirmed 45 HGG treated with combined chemoradiotherapy and adjuvant chemotherapy.According to the Response Assessment in neuro-Oncology?RANO?standard,those patients were divided into progressive and non progressive group,quantitatively analysis of postsurgical cavity FLAIR signal by measuring image gray value using ImageJ software.Two independent samples t test were used to compare the differences of clinical indicators and related parameters between the progression and non progression group.Using ROC curve to determine the threshold value,accuracy,sensitivity,specificity,positive predictive value and negative predictive value.The patients were divided into two groups according to the threshold value,the survival rate of PFS was analyzed by Kaplan-Meier method and Log-rank test,P < 0.05 was statistically significant.The kappa consistency test was used to evaluate the consistency between intra-observers and inter-observers,according to the RANO standard we determined tumor progression.The intraclass correlation coefficient?ICC?was used to evaluate the consistency of the data with the residual cavity and background gray value?C-B?measured by intra-observers and inter-observers.Results: According to the RANO standard,the cases were divided into two groups progressing group?n=33?and non-progressing group?n=12?.There was no significant difference between the two groups in the maximum diameter of the postsurgical cavity and the follow-up time?P value was 0.264,0.159?.The difference of cavity and background gray value?C-B?in FLAIR sequence in the progression group and the non progression group was 71.260±5.097,28.930±6.876?t=-2.596,P=0.014?.The PFS of the non progression group and the progression group were180.740±15.628 d,384.75±47.220d?t=-2.703,P= 0.008?.C-B value predicts tumor progression the area under ROC curve,threshold,sensitivity,specificity,positive predictive value and negative predictive were 0.875,62.3,69.7%,0.84,0.50 respectively.The patients were divided into high and low signal group by C-B 62.3,there was significant difference between the two groups of PFS,178.630 ± 19.573 d,299.730 ± 35.949d?t=-3.060,P=0.004?.According to the Response Assessment in neuro-Oncology?RANO?standard,those patients were divided into progressive and non progressive group,intra group and inter group K value were0.951 and 0.981 respectively.The measurement of C-B by two observers,the inter-observer ICC was 0.982,intra-observer ICC was 0.989.Conclusion:The postsurgical FLAIR signal in the progression group was higher than in non-progression group,These results suggest that the increase of FLAIR signal in postsurgical cavity can be used as a predictive index for tumor progression and poor prognosis.Part 2 Patterns of enhancing lesions in posttreatment high grade gliomas for progression and prognosis predictionObjective:The purpose of this study is to investigate the value of morphology of small enhancing lesions in evaluating the progression and progression free survival?PFS?in patients with high-grade gliomas?HGG?.Methods:A total of 51 consecutive patients with pathology confirmed HGG treated with combined chemoradiotherapy and adjuvant chemotherapwere collected in this study,MR data of those patients were retrospectively studied.According to the Response Assessment inneuro-Oncology?RANO?standard,those patients were divided into progressive and non progressive group.Using Kappa consistency test in evaluating the agreement of intra and inter group,the consistency of enhanced lesion diameter between inter-observer and intra-observer was tested by ICC.Chi square test was used to compare the difference of the three kinds of morphological enhancement in the progression group and the non-progression group,Kaplan-Meier method was used to analyze the survival of the three groups?thin line group,thick line group,nodule group?.The difference of survival rate was compared by Log-rank test,the difference was statistically significant with P<0.05.Results: According to the RANO standard,the cases were divided into two groups progressing group?n=27?and non-progressing group?n= 24?,intra-group and inter group k value were 0.960 and 0.881 respectively.The inter-observer and intra-observer ICC of enhanced lesion diameter were 0.975 and 0.992.The constituent ratio of patterns of enhancing lesions in progression group and non progression group were had obvious differences.non progression group,thin wall enhancement pattern83.3%?20/24?,thick wall enhancement pattern4.2%?1/24?,nodular wall enhancement pattern12.5%?3/24?.progression group,thin wall enhancement pattern 7.4%?2/27?,thick wall enhancement pattern 33.3%?9/27?,nodular wall enhancement pattern59.3%?16/27?,P<0.05.Thin wall,thick wall and nodular wall enhancement pattern PFS were 494.82±343.190 d,259.70±141.176 d,254.42±182.269 d,respectively,P=0.003.Conclusion:Thin enhancement pattern was more common in the non progression group than in progression group.Thick and nodular enhancement pattern were more common in the progression group;The enhancement of small lesions form can predict the progress and prognosis of HGG after treatment.Part 3 Post-treatment progression and survival prediction of high-grade glioma: Evaluated with ADC histogramObjective:The purpose of this study is to investigate the value ofparameters of high b?3000/2000?DWI ADC map in evaluating the progression and C₅ evaluating progression free survival?PFS?in patients with HGG after chemoradiotherapy.Methods:A total of 53 consecutive patients with pathology confirmed HGG treated with chemoradiotherapy and adjuvant chemotherapy were enrolled.Those patients had received conventional MRI and high b?2000s/mm²,3000s/mm²?DWI examination,we measured of ADC_mean,rADC_mean and C₅ corresponding to T1 WI enhancement region in 3000/2000 b value ADC map.Wilcoxon rank sum test was used to compare the differences of ADC_mean,rADC_mean and C₅ in the progression group and the non progression group.Using ROC curve to determine the optimal threshold value,diagnostic accuracy of ADC_mean,rADC_mean and C₅ in determining tumor progression.Those patients were divided into two groups by the threshold value of C₅,survival analysis was used Kaplan-Meier method and Log-rank test was used to compare the survival rates.Using Kappa consistency test in evaluating the agreement tumor progression,the consistency of ADC_mean,C₅ and rADC_mean between inter-observer and intra-observer were tested by ICC.Results: According to the RANO standard,the cases were divided into two groups progressing group?n=30?and non-progressing group?n=23?,ADC_mean,C₅ and rADC_mean of high b?3000/2000?DWI ADC map were different in progression group and the non-progression group.ADC_mean,C₅ and rADC_mean between progression group and the non-progression group were190.00?31.25?mm²/s,326.00?26?mm²/s,Z=-2.777,P=0.005,359.50?39?mm²/s,519.00?59?mm²/s,Z=-2.193,P=0.028,0.86?0.08?mm²/s,1.46?0.04?mm²/s,Z=-2.071,P=0.038 respectively.C₅,ADC_mean and rADC_mean of high b value DWI map in determining tumor progression the area under ROC curve,threshold,sensitivity,specificity,positive predictive value and negative predictive were 0.968,291,93.3%,91.3%;0.883,426,90%,91.3%;0.901,1.335,96.7%,86.7% respectively.The C₅ values of 291mm²/s could be used to predict PFS,Log Rank test,P < 0.05.According to the ResponseAssessment in neuro-Oncology?RANO?standard,those patients were divided into progressive and non progressive group,intra-group and inter-group k value were 0.807 and 0.885 respectively.The inter-observer and intra-observer ICC of C₅?ADC_mean and rADC_mean were0.991,0.994,0.943,0.970,0.952,0.965 respectively.Conclusion:High b value ADC?3000/2000?histogram played an important role in judging tumor progression in post-treatment HGG,and C₅ had the highest accuracy of those parameters.