Altern Ther Health Med. 2023 Oct 27:AT9342. Online ahead of print.
ABSTRACT
OBJECTIVE AND SIGNIFICANCE: Glioblastoma is a highly invasive brain tumor, and its treatment and management have long posed challenges in the fields of neurosurgery and oncology. This study aimed to explore the potential value of apparent diffusion coefficient (ADC) values in postoperative recurrent brain gliomas using magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI), with the goal of providing clinicians with more precise decision-making tools. In the context of the therapeutic challenges posed by glioblastomas, this research holds significant importance. The treatment of glioblastomas typically involves surgical resection, radiotherapy, and chemotherapy; however, its recurrence rate remains relatively high. Early detection of recurrence is crucial for implementing timely interventions, as it can impact patient survival and quality of life. ADC values within DWI may serve as a non-invasive tool to aid in the identification of potential recurrent lesions, thereby facilitating earlier therapeutic actions.
METHODS: A retrospective analysis was conducted on clinical data from 52 patients diagnosed with brain gliomas. All patients underwent MRI scans, contrast-enhanced imaging, and DWI. Based on the pathology results from the second surgery or radiological follow-up, patients were categorized into two groups: the recurrent group (31 cases) and the non-recurrent group (21 cases). The MRI diagnostic criteria followed the Chinese Guidelines for Diagnosis and Treatment of Central Nervous System Gliomas (2015 edition), and gliomas were classified into grades I-IV according to the WHO (2007 edition) pathological grading standards. Inclusion criteria encompassed postoperative pathological diagnosis of brain gliomas, absence of intracranial surgeries, brain parenchymal injuries, or other relevant medical histories, and all patients received postoperative adjuvant radiotherapy with a total dose exceeding 50 Gy, coupled with chemotherapy. Exclusion criteria excluded patients diagnosed with cerebral infarction, those with other intracranial conditions such as intracranial hypertension, and individuals with hepatic or renal dysfunction or known contrast agent allergies. ADC values for both groups were separately calculated, and receiver operating characteristic (ROC) curves were constructed. ROC area under the curve (AUC) was employed to assess the diagnostic accuracy of the two methods, along with the calculation of sensitivity (Sen) and specificity (Spe).
RESULTS: The ADCmean values (1.05 ± 0.25 mmys) and relative ADC (rADC)mean values (1.17 ± 0.38 mmys) of the recurrent group were lower than those of the non-recurrent group (1.33 ± 0.21 mmys, 1.36 ± 0.24 mmys), while the ADCmin values (1.03 ± 0.18 mmys) and ADCmax values (1.19 ± 0.21 mmys) of the recurrent group were lower than those of the non-recurrent group (1.21 ± 0.12 mmys, 1.35 ± 0.17 mmys), with statistically significant differences (P < .05). The AUC of ADCmean was 0.785, with Sen and Spe of 93.75% and 55%, respectively. The AUC of rADCmean was 0.702, with Sen and Spe of 86.2% and 65.21%, respectively. The AUC of ADCmin was 0.824, with Sen and Spe of 86.66% and 68.18%, respectively. The AUC of ADCmax is 0.715, with Sen and Spe of 77.77% and 60%, respectively.
CONCLUSION: The results of this study demonstrated the potential clinical utility of ADC values in the diagnosis of postoperative recurrence in gliomas. ROC analysis revealed that ADC values exhibited a high diagnostic accuracy, with the AUC reflecting their discriminative ability between the recurrence and non-recurrence groups. This finding may assist clinical practitioners in more precisely assessing patients’ risk of recurrence, further optimizing treatment strategies, and enhancing both survival rates and quality of life. Nevertheless, it is important to acknowledge several limitations in this study. Firstly, the relatively small sample size may limit the generalizability of the results. Additionally, due to the observational nature of this study, larger-scale and multicenter research is still required to validate these findings. Lastly, ADC values are influenced by various factors, including technical parameters and equipment variations, which necessitate further standardization and calibration efforts. Thus, while the results of this study hold promise for improving the management of glioma patients, further research is warranted to fully understand their potential clinical value.
PMID:37883754
