动态对比增强磁共振成像预测高级别胶质瘤IDH基因突变的价值  

The value of DCE-MRI in predicting IDH gene mutation of high-grade gliomas

作　　者：卢海涛[1] 邢伟[1] 张艳文[1] 秦华平[2] 吴汝洪 丁玖乐[1] Lu Haitao;Xing Wei;Zhang Yanwen;Qin Huaping;Wu Ruhong;Ding Jiule(Department of Radiology,First People′s Hospital of Changzhou,Changzhou 213003,China;Department of Neurosurgery,First People′s Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]常州市第一人民医院影像科,常州213003 [2]常州市第一人民医院神经外科,常州213003

出　　处：《中华医学杂志》2019年第39期3105-3109,共5页National Medical Journal of China

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)定量及半定量参数对高级别胶质瘤IDH基因突变的术前预测价值。方法回顾性分析常州市第一人民医院2016年4月至2019年6月经手术病理证实的26例世界卫生组织(WHO)Ⅲ~Ⅳ级胶质瘤,按照分子病理结果分为IDH突变组(7例,男3例、女4例,年龄27~67岁)和IDH野生组(19例,男12例、女7例,年龄42~75岁)。所有病例术前均行T1WI及增强、T2WI及DCE检查。测量容积转运常数(K^trans)、速率常数(Kep)、血管外细胞外容积分数(Ve)、血浆容积分数(Vp)四个定量参数图及达峰时间(TTP)、最大浓度(MAX Conc)、增强曲线下初始面积(IAUC)、最大斜裂(MAX Slope)等四个半定量参数。采用独立样本t检验(满足正态分布及方差齐性)或Mann-Whitney秩和检验(不满足正态分布或方差齐性)比较IDH突变组与IDH野生组DCE-MRI各参数的差异。采用受试者工作特征(ROC)曲线评价DCE各参数术前预测高级别胶质瘤IDH基因突变的效能。结果IDH突变组K^trans、TTP值分别为0.096(0.080,0.135)/min、(3.95±0.34)s,IDH野生组K^trans、TTP值分别为0.168(0.132,0.337)/min、(2.58±1.15)s。IDH突变组K^trans显著<IDH野生组(Z值为-2.168,P值为0.030);IDH突变组TTP显著>IDH野生组(Z值为-2.630,P值为0.007)。K^trans、TTP值预测高级别胶质瘤IDH基因突变的ROC曲线下面积(AUC)分别为0.782、0.842,K^trans对预测的特异度更高(73.7%),TTP的敏感度更高(100.0%)。联合K^trans及TTP预测高级别胶质瘤IDH基因突变的效能最大,AUC为0.865。结论DCE-MRI定量及半定量参数有助于高级别胶质瘤IDH基因突变的术前预测。Objective To investigate the value of quantitative and semiquantitative parameters of DCE-MRI in predicting IDH gene mutation of high-grade gliomas before the operation.Methods Twenty-six individuals with surgically and pathologically proved WHOⅢ-Ⅳgliomas collected from April 2016 to June 2019 in First People′s Hospital of Changzhou,were divided into two groups,IDH mutation group(7 cases,27-67 years,3 males and 4 females,)and IDH gene wild group(19 cases,42-75 years,12 males and 7 females)according to the results of molecular pathology.All individuals underwent conventional plain(T1WI,T2WI),enhanced MR scanning(T1WI)and dynamic contrast enhancement(DCE).Four quantitative parameters:volume transfer constant(K^trans),ratio constant of back flux(Kep),extravascular extracellular space fractional volume(Ve),and blood plasma fractional volume(Vp),and four semiquantitative parameters:time to peak(TTP),maximum concentration(MAX Conc),initial area under the gadolinium concentration-time curve(IAUC)and maximum slope of decrease(MAX Slope)were measured.The independent samples t test(normal distribution and homogeneity of variance)or Mann-Whitney rank sum test(abnormal distribution or heterogeneity of variance)were used to compare the differences of quantitative and semiquantitative parameters between IDH gene mutation group and IDH gene wild type group.Receiver operating characteristic(ROC)curve was used to evaluate the efficiency of quantitative and semiquantitative parameters in predicting IDH gene mutation of high-grade gliomas.Results The value of K^trans,TTP in IDH mutated group were 0.096(0.080,0.135)/min and(3.95±0.34)s,respectively.The value of K^trans,TTP in IDH wild type group were 0.168(0.132,0.337)/min and(2.58±1.15)s,respectively.The value of K^trans in IDH mutated group was significantly less than the value of K^trans in IDH gene wild type group(Z value was-2.168,P value was 0.030).The value of K^trans in IDH mutated group was significantly greater than the value of K^trans in IDH gene wild type(Z valu

关 键 词：磁共振成像 神经胶质瘤 突变 动态增强扫描 

分 类 号：R73[医药卫生—肿瘤]