氨基质子转移成像对脑胶质瘤分级及异柠檬酸脱氢酶、Ki-67、p53表达的诊断及预测价值  

Diagnostic and Predictive Efficacy of Amide Proton Transfer MRI in Tumor Grading, Isocitrate Dehydrogenase Status and the Expression Level of Ki-67 and p53 in Gliomas

作　　者：张浩 崔园园[2] 冯杰[2,3] 彭虹[2] 张君 王岩 王玉林[2] 肖华锋[2] 陈新静[2] 马林[1,2] ZHANG Hao;CUI Yuanyuan;FENG Jie;PENG Hong;ZHANG Jun;WANG Yan;WANG Yulin;XIAO Huafeng;CHEN Xinjing;MA Lin(Chinese PLA Medical School,Beijing 100853,China;Department of Radiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心放射诊断科,北京100853 [3]武警山西总队医院医学影像科,山西太原034099

出　　处：《中国医学影像学杂志》2020年第5期327-332,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨氨基质子转移(APT)MRI对胶质瘤分级、异柠檬酸脱氢酶(IDH)、Ki-67、p53表达水平的诊断及预测价值。资料与方法回顾性分析59例胶质瘤患者的MRI平扫、增强扫描图像、APT图像及其病理和免疫组化资料,在APT图像上观察肿瘤及其周围信号特点,并将APT图像分为5个等级。分析APT图像等级与肿瘤WHO分级的相关性,判断随APT图像等级增高IDH野生型、Ki-67、p53高表达所占百分比的变化趋势,比较APT图像等级在胶质瘤高低级别、不同IDH状态、不同Ki-67、p53表达水平之间的差异,采用受试者工作特征(ROC)曲线分析诊断效能。结果 59例胶质瘤中,WHOⅡ级22例,Ⅲ级12例,Ⅳ级25例。59例中IDH突变型22例,野生型37例;Ki-67低表达6例,高表达53例;54例中p53低表达14例,高表达40例。APT图像等级与WHO分级呈显著正相关(r=0.6,P<0.001),随APT图像等级增高,IDH野生型与突变型、Ki-67、p53高表达与低表达之间的比率逐渐上升(χ2 for trend=7.251,P=0.007;χ2 for trend=4.229,P=0.04;χ2 for trend=6.387,P=0.011);低级别胶质瘤、IDH突变型组、Ki-67低表达组、p53低表达组APT图像等级低于高级别胶质瘤、IDH野生型组、Ki-67高表达组、p53高表达组(P<0.05),ROC曲线下面积分别为0.78、0.703、0.758、0.712(P<0.01)。结论胶质瘤高低级别、不同IDH状态、不同Ki-67及p53表达水平APT图像信号具有差异,定性地应用APT成像可以对免疫组化因子进行诊断和预测。Purpose To investigate and evaluate the diagnostic and predictive efficacy of amide proton transfer(APT) MRI in tumor grading, isocitrate dehydrogenase(IDH) status, and the expression level of Ki-67 and p53 in gliomas. Materials and Methods Conventional MRI, post contrast images, APT images, and the pathology were retrospectively analyzed in 59 pathologically proved patients with gliomas. APT images were classified into five grades based on the signal features of tumors and their peripheral regions. Correlation between APT image grade and tumor grading was analyzed. The variation trends for the percentage of IDH wild type, high level expression of Ki-67 and p53 along with the variation of the APT image grades were evaluated. Differences between APT image grade and tumor grading, IDH, Ki-67, and p53 were respectively analyzed. ROC curve analysis was performed to evaluate the diagnostic efficacy. Results Of the 59 glioma patients, 22 were WHO grade Ⅱ, 12 were grade Ⅲ, and 25 were grade Ⅳ. 22 were with IDH mutation and 37 with IDH wild type. 6 were with lower Ki-67 expression and 53 with higher Ki-67 expression. Of the 54 patients with p53 test, 14 were with lower expression, and 40 with higher expression. APT image grade was positively correlated with WHO grading(r=0.6, P<0.001). The variation trend for the percentage of IDH wild type, high level expression of Ki-67 and p53 along with the increasing of the APT image grade was ascending(χ~2 for trend=7.251, P=0.007;χ~2 for trend=4.229, P=0.04;χ~2 for trend=6.387, P=0.011). APT image grades in patients with low grade glioma, IDH mutation, lower Ki-67 expression, and lower p53 expression were lower than those in high grade glioma, IDH wild type, higher Ki-67 expression, and higher p53 expression(P<0.05), AUC was 0.78, 0.703, 0.758 and 0.712(P<0.01), respectively. Conclusion As APT signals between high grade and low grade, different IDH status, the high and low expression level of Ki-67 and p53 in gliomas are statistically different, qualitative application of

关 键 词：脑肿瘤 神经胶质瘤 磁共振成像 氨基质子转移成像 异柠檬酸脱氢酶 KI-67抗原 基因 p53 诊断 预测 

分 类 号：R739.41[医药卫生—肿瘤] R730.42[医药卫生—临床医学]