Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Differentiation of True Recurrence from Delayed Radiation Therapy-related Changes in Primary Brain Tumors Using Diffusion-weighted Imaging, Dynamic Susceptibility Contrast Perfusion Imaging, and Susceptibility-weighted Imaging

확산강조영상, 역동적조영관류영상, 자화율강조영상을 이용한 원발성 뇌종양환자에서의 종양재발과 지연성 방사선치료연관변화의 감별

  • Kim, Dong Hyeon (Department of Radiology, Seoul National University College of Medicine) ;
  • Choi, Seung Hong (Department of Radiology, Seoul National University College of Medicine) ;
  • Ryoo, Inseon (Department of Radiology, Seoul National University College of Medicine) ;
  • Yoon, Tae Jin (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, Tae Min (Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine) ;
  • Lee, Se-Hoon (Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine) ;
  • Park, Chul-Kee (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Kim, Ji-Hoon (Department of Radiology, Seoul National University College of Medicine) ;
  • Sohn, Chul-Ho (Department of Radiology, Seoul National University College of Medicine) ;
  • Park, Sung-Hye (Department of Pathology, Seoul National University College of Medicine) ;
  • Kim, Il Han (Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine)
  • 김동현 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 최승홍 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 유인선 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 윤태진 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 김태민 (서울대학교 의과대학 서울대학교병원 내과) ;
  • 이세훈 (서울대학교 의과대학 서울대학교병원 내과) ;
  • 박철기 (서울대학교 의과대학 서울대학교병원 신경외과) ;
  • 김지훈 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 손철호 (서울대학교 의과대학 서울대학교병원 영상의학과) ;
  • 박성혜 (서울대학교 의과대학 서울대학교병원 병리과) ;
  • 김일한 (서울대학교 의과대학 서울대학교병원 방사선종양학과)
  • Received : 2014.05.10
  • Accepted : 2014.06.18
  • Published : 2014.06.30
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Abstract

Purpose : To compare dynamic susceptibility contrast imaging, diffusion-weighted imaging, and susceptibility-weighted imaging (SWI) for the differentiation of tumor recurrence and delayed radiation therapy (RT)-related changes in patients treated with RT for primary brain tumors. Materials and Methods: We enrolled 24 patients treated with RT for various primary brain tumors, who showed newly appearing enhancing lesions more than one year after completion of RT on follow-up MRI. The enhancing-lesions were confirmed as recurrences (n=14) or RT-changes (n=10). We calculated the mean values of normalized cerebral blood volume (nCBV), apparent diffusion coefficient (ADC), and proportion of dark signal intensity on SWI (proSWI) for the enhancing-lesions. All the values between the two groups were compared using t-test. A multivariable logistic regression model was used to determine the best predictor of differential diagnosis. The cutoff value of the best predictor obtained from receiver-operating characteristic curve analysis was applied to calculate the sensitivity, specificity, and accuracy for the diagnosis. Results: The mean nCBV value was significantly higher in the recurrence group than in the RT-change group (P=.004), and the mean proSWI was significantly lower in the recurrence group (P<.001). However, no significant difference was observed in the mean ADC values between the two groups. A multivariable logistic regression analysis showed that proSWI was the only independent variable for the differentiation; the sensitivity, specificity, and accuracy were 78.6% (11 of 14), 100% (10 of 10), and 87.5% (21 of 24), respectively. Conclusion: The proSWI was the most promising parameter for the differentiation of newly developed enhancing-lesions more than one year after RT completion in brain tumor patients.

목적: 원발성 뇌종양환자에서 방사선 치료 후 추적 자기공명영상에서 새로 생긴 조영증강 뇌병변에 대해 종양재발과 지연성 방사선치료연관변화의 감별에 있어서 확산강조영상 (DWI), 역동적조영관류영상 (DSC PWI), 자화율강조영상 (SWI)의 진단적 가치를 서로 비교하고자 한다. 대상과 방법: 원발성 뇌종양으로 이전에 방사선치료를 받았던 환자 중, 방사선치료 종료 최소 1년 이후에 추적 자기공명영상에서 새롭게 조영증강 되는 병변을 가진 24명의 환자를 대상으로 연구하였다. 새롭게 조영증강 되는 병변은 14명의 종양재발과 10명의 방사선치료연관변화로 확인되었다. 종양재발과 방사선치료연관변화 두 환자 군의 여러변수들은 비대응표본 t 검정을 실시하여 비교 분석하였다. 다중변수 로지스틱 회귀 분석을 이용하여 DWI, DSC PWI, SWI 각 영상의 정량 분석을 통해 얻은 apparent diffusion coefficient (ADC), normalized cerebral blood volume (nCBV), proportion of dark signal intensity (proSWI) 값 중 두 군을 감별해 내는 최상의 예측 변수 (best predictor)를 정하였다. 이후 수신자 조작 특성 (Receiver operating characteristics, ROC) 분석을 통하여 best predictor의 정확도, 민감도, 특이도를 평가하였다. 결과: 방사선치료연관변화 군과 비교하여 종양재발 군에서 평균 nCBV 값이 유의하게 높았고 (P=.004), 평균 proSWI 값은 유의하게 낮았다 (P<.001). 반면, 평균 ADC 값은 두 군간에 유의한 차이를 보이지 않았다. 다중변수 로지스틱 회귀 분석 결과 proSWI 값만이 통계적으로 유의한, 감별 가능한 독립변수였으며, 민감도, 특이도, 정확도는 각각 78.6% (11 of 14), 100% (10 of 10), 87.5% (21 of 24) 였다. 결론: 뇌종양 환자에서 방사선치료 종료 최소 1년 이후에 새로 보이는 조영증강 병변의 감별에 있어 proSWI 값이 가장 중요한 변수인 것으로 나타났다.

Keywords

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