Napredne tehnike magnetne rezonance u ranom razdvajanju pseudoprogresije od progresije kod bolesnika sa glioblastomom multiforme
Sažetak
Uvod/Cilj. Uvođenje tretmana glioblastoma zračnom terapijom uz konkurentnu i adjuvantnu primenu temozolomida (CRT) dovelo je do pojave nove dijagnostičke dileme – potrebe za razlikovanjem pseudo-progresije i presudoodgovora. Razlikovanje snimaka magnetne resonance (MR) ova dva fenomena za sada je moguće samo evaluacijom u više vremenskih tačaka u toku terapije, dok nove tehnike koje bi pomogle u njihovom razlikovanju nisu još uvedene. U radu je analizirana mogućnost primene time-to-peak (TTP) mapa dinamičkog perfuzionog imidžinga i magnetno rezonantne spektroskopije u utvrđivanju odgovora tumora na terapiju. Metode. Analizirano je 40 bolesnika sa primarnim glioblastomom multiforme. Bolesnici su snimani u trećoj nedelji nakon operacije i desetoj nedelji od početka CRT. Pregledi na aparatu za MR rađeni su na aparatu 1.5 T Avanto Siemens, Erlangen Nemačka. Mape perfuzionih parametara generisane su i analizirane korišćenjem programa DPtools v3.79. 3D CSI PRESS spektroskopija sa dugim i kratkim vremenom eha rađena je kod svih bolesnika. Rezultati. Kod 32 od 40 bolesnika dijagnostikovana je progresija bolesti, a kod osam je dijagnostikovana pseudo-progresija. Kod bolesnika sa progresijom bolesti dobijene time-to-peak vrednosti su bile 33 ± 7 s u trećoj nedelji i 30 ± 5 s u desetoj nedelji, što ne predstavlja statistički značajnu razliku. Vrednosti ovog parametra za pseudoprogresiju bile su 32 ± 8 s u trećoj i 43 ± 9 s u desetoj nedelji što je statistički značajna razlika (p < 0.05). Rezultati spektroskopije ukazali su na prisustvo glicinskog pika kod šest bolesnika sa progresijom bolesti, dok kod pseudoprogresije ovaj metabolit nije bio prisutan. Zaključak. Analizirani MR snimci pokazali su da je MR veoma uspešna tehniku za postavljanje dijagnoze progresije bolesti tokom terapije kod bolesnika sa glioblastomom.
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