ABSTRACT
Objective To investigate the value of conventional MR texture analysis of peritumoral edema in differentiating between glioblastoma and solitary metastatic brain tumor. Methods Forty patients with brain glioma and forty patients with brain metastases confirmed by pathology or clinic were enrolled . All patients underwent conventional MRI scan and enhanced examination, including axial T1WI, T2WI, fluid attenuated inversion recovery(FLAIR) and enhanced T1WI. The ROI was manually outlined by MaZda software in the most obvious level of 4 sequences of peritumoral edema and the texture features were extracted, including mean, variance, skewness, kurtosis, 1 percentile, 10 percentile, 50 percentile, 90 percentile, 99 percentile. Independent sample t-test (in case of normality and variance homogeneity test) or rank sum test (in case of not satisfying normality and homogeneity of variance) was used to compare the differences of the histogram parameters and to make meaningful parameters based on logistic regression modeling and drawing the receiver operating characteristic curve (ROC curve) to evaluate the differential diagnosis efficacy. Results Through the preliminary feature screening, skew of FLAIR (SkewFLAIR) for glioblastomas was -0.358±0.432, respectively,while for solitary metastatic brain tumor, the statistics was-0.648 ± 0.503. The results showed statistically significant difference(t=7.574,P=0.006). The differencesbetween the kurtosis (KurtFLAIR) were also proven to be statistically significant (Z=4.360 ,P=0.037),with-0.384 (-0.798, 0.049) for glioblastomas and-0.089 (-0.456, 0.613) for solitary metastasis brain tumor. The sensitivity of the corresponding logistic regression differential diagnosis model was 77.5％, specificity was 94.3％, and area under the curve (AUC) was 0.85. Conclusion Conventional MRI texture analysis of peritumoral edema provides reliable and quantified objective basis for the differential diagnosis of glioblastoma and solitary metastasis.
ABSTRACT
STUDY DESIGN: To analyze the clinical and radiological outcomes retrospectively. PURPOSE: To evaluate the efficacy of a total en bloc spondylectomy in solitary metastatic spinal tumors. SUMMERY OF LITERATURE REVIEW: In a conventional operation of a spinal metastatic tumor it is difficult to perform a wide excision, and several reports have suggested a total en bloc spondylectomy for wide or marginal resections. MATERIALS AND METHODS: Ten patients, with solitary spinal metastasis, were underwent a total en bloc spondylectomy, with a mean follow-up of 15 months. The locations of the tumors were the thoracic spine and lumbar spine in 4 and 6 cases, respectively. The clinical and radiological outcomes were assessed using the McAfee pain scale, Frankel neurologic grading, radiological extent of the lesion and local recurrence. Metastatic spinal tumors were classified by the system of Tomita. A pathological study of the resected vertebra was performed to evaluate the surgical margin. RESULTS: The preoperative back pain was grades IV, III, II and 0 in 4, 3, 2 and 1 case, respectively. The postoperative back pain was grades III, I and 0 in 3, 1 and 6 cases by the McAfee pain scale, respectively. The neurologic deficit was improved completely in all cases. There were 3 and 7 cases of types 4 and 5 by the Tomita's classification, respectively. The pathological results were wide margin and marginal margin in 4 and 6 cases, respectively. There were no local recurrences at the time of the last follow-up. CONCLUSION: All patients maintained good clinical and radiological results. A total en bloc spondylectomy was a useful treatment option for solitary metastatic tumors.