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目的胶质母细胞瘤(GBM)化疗和放疗(以下称放化疗)后常规MR影像显示进展者,比较纳米氧化铁和钆特醇测量的相对脑血容量(rCBV),以及rCBV与存活时间的关系。材料与方法所有病人取得知情同意书并经伦理委员会登记。19例GBM病人放化疗后常规MR影像显示明显进展,行钆特醇和纳米氧化铁MR灌注成像,获得对比剂漏出图和rCBV。针对每种对比剂,以及钆特醇有无对比剂漏出校正,将病人分类,高rCBV(>1.75)提示肿瘤,低rCBV(≤1.75)提示假进展。用对数秩检验Kaplan-Meier生存曲线和Cox比例风险模型行统计学分析。结果使用纳米氧化铁时,9例病人(47%)低rCBV,中位总生存期(mOS)为591d,10例病人(53%)高rCBV,mOS为163d。风险比0.098(P=0.004)提示生存期显著提高。使用钆特醇时,14例病人(74%)低rCBV,mOS为474d,5例病人(26%)高rCBV,mOS为156d,风险比0.399(P=0.093)无统计学意义。5例两种方法结果不一致,纳米氧化铁显示高rCBV而钆特醇显示低rCBV的病人mOS为171d。进行漏出校正后,钆特醇测得的rCBV与生存期显著相关(风险比0.12;P=0.003)。结论血池对比剂纳米氧化铁有助于鉴别肿瘤进展和假进展,是一种良好的预后生物标记,且与钆特醇不同,无需对比剂漏出校准。
Routine MR imaging showed progression after glioblastoma (GBM) chemotherapy and radiotherapy (hereinafter referred to as chemoradiation) comparing the relative cerebral blood volume (rCBV) measured with nano-iron oxide and gadoteridol, and the relationship between rCBV and survival time relationship. Materials and Methods All patients were given informed consent and registered with the Ethics Committee. In 19 patients with GBM, conventional MR imaging showed significant progress after chemoradiation. Contrast agent leakage and rCBV were obtained through perfusion with gadoteridol and iron oxide nanoparticles. For each contrast agent, and whether Gadoterol leakage was corrected with contrast agent, the patients were classified, with high rCBV (> 1.75) suggestive of tumor and low rCBV (≤ 1.75) suggesting false advance. Statistical analysis was performed using log-rank test Kaplan-Meier survival curve and Cox proportional hazards model. Results Nine patients (47%) had low rCBV with a median overall survival (mOS) of 591 days and ten patients (53%) had high rCBV with mOS of 163 days when using nano-iron oxide. The odds ratio 0.098 (P = 0.004) suggested a significant increase in survival. With gadoteridol, 14 patients (74%) had low rCBV and mOS of 474 days. Five patients (26%) had high rCBV with mOS of 156 days and a hazard ratio of 0.399 (P = 0.093) was not statistically significant. The results of the two methods were inconsistent in 5 cases, with high rCBV in iron oxide nanoparticles and 171 days in patients with low rCBV with gadoteridol. After leakage correction, rCBV measured with gadoteridol was significantly associated with survival (hazard ratio 0.12; P = 0.003). Conclusion The blood pool contrast agent nano-iron oxide can help to identify tumor progression and false progression. It is a good prognostic biomarker and unlike Gadoteridol, no contrast leakage is required for calibration.