Sy-MRI联合DWI在预测胶质瘤MGMT甲基化中的应用  

Application of Sy-MRI combined with DWI in predicting MGMT methylation in glioma

作　　者：马文富 葛鑫 党佩 黄雪莹[3] 吕瑞瑞 郑佳瑞 张伟[3] 王晓东[3] MA Wenfu;GE Xin;DANG Pei;HUANG Xueying;LÜRuirui;ZHENG Jiarui;ZHANG Wei;WANG Xiaodong(Clinical Medical College,Ningxia Medical University,Yinchuan 750004,China;The Second Clinical Medical College of Lanzhou University,Lanzhou 730030,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]兰州大学第二临床医学院,兰州730030 [3]宁夏医科大学总医院放射科,银川750004

出　　处：《磁共振成像》2023年第7期18-24,48,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：宁夏回族自治区自然科学基金(编号:2023AAC03557);宁夏回族自治区卫生健康系统科研课题(编号:2023-NWKYP-046)。

摘　　要：目的探讨集成MRI(synthetic MRI,Sy-MRI)联合扩散加权成像(diffusion weighted imaging,DWI)在预测胶质瘤O6-甲基鸟嘌呤-DNA甲基转移酶(O^(6)-methylguanine-DNA methyltransferase,MGMT)启动子甲基化状态中的应用价值。材料与方法前瞻性纳入2020年10月至2021年12月在宁夏医科大学总医院行肿瘤切除术并具有完整病理结果及免疫组化的胶质瘤患者47例,所有患者术前均在GE Architect 3.0 T超导型磁共振扫描仪接受Sy-MRI及DWI序列扫描,根据术后MGMT启动子甲基化的病理结果分为甲基化组和非甲基化组。对增强前后的Sy-MRI各参数图(pre-T1、post-T1、pre-T2、post-T2、pre-PD及post-PD)与基于DWI的表观扩散系数(apparent diffusion coefficient,ADC)图进行配准,随后测量胶质瘤实质部分在上述参数图的信号。采用独立样本t检验或Mann-Whitney U检验对比MGMT启动子甲基化组和非甲基化组各参数的差异,对差异有统计学意义的参数采用多因素logistic回归分析。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各参数独立及其联合诊断MGMT启动子甲基化的效能,并采用DeLong检验对比ROC曲线下面积(area under the curve,AUC)的差异。结果MGMT启动子甲基化组post-T1、pre-T2、post-T2、post-PD值低于非甲基化组,差异有统计学意义(P<0.05),pre-T1、pre-PD值两组间差异无统计学意义(P>0.05),甲基化组ADC值低于非甲基化组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,pre-T2[OR=1.031,95%置信区间(confidence interval,CI):1.002~1.062,P=0.038]、post-T1(OR=1.003,95%CI:1.001~1.007,P=0.015)、ADC(OR=1.041,95%CI:1.008~1.072,P=0.047)是预测胶质瘤MGMT甲基化的独立影响因素。ROC曲线分析结果显示,pre-T2、post-T1及ADC值独立诊断MGMT启动子甲基化的AUC值分别为0.722、0.808及0.685,上述三参数联合模型诊断MGMT启动子甲基化的AUC为0.815。DeLong检验结果显示联合参数模型的诊断效能高于ADC值,�Objective:To investigate the value of synthetic MRI(Sy-MRI)combined with diffusion weighted imaging(DWI)in predicting the methylation status of O^(6)-methylguanine DNA methyltransferase(MGMT)promoter in glioma.Materials and Methods:Forty-seven patients with gliomas who underwent tumor resection in the General Hospital of Ningxia Medical University from October 2020 to December 2021 were prospectively collected.All patients were scanned by Sy-MRI and DWI sequence at the GE Architect 3.0 T superconducting MR scanner before operation.According to the pathological results of MGMT promoter methylation after the operation,they were divided into methylation group and non-methylation group.The pre-and post-enhanced Sy-MRI parameter maps(pre-T1,post-T1,pre-T2,post-T2,pre-PD and post-PD)were registered with the DWI-based apparent diffusion coefficient(ADC)map,and then the signal of the glioma parenchyma in the above parameter map was measured.The independent sample student's t-test or Mann-Whitney U test was used to compare the differences between the parameters of the methylation group and the non-methylation group of MGMT promoter.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of independent and combined diagnosis of MGMT promoter methylation,and the DeLong test was used to compare the difference of area under ROC curve(AUC).Results:The values of post-T1,pre-T2,post-T2,and post-PD in the MGMT promoter methylation group were lower than those in the non-methylation group,with a statistically significant difference(P<0.05).The values of pre-T1 and pre-PD had no statistically significant difference between the two groups(P>0.05).The ADC values in the methylation group were lower than those in the non-methylation group,with a statistically significant difference(P<0.05).Multivariate logistic regression analysis showed that pre-T2[OR=1.031,95%confidence interval(CI):1.002-1.062,P=0.038],post-T1(OR=1.003,95%CI:1.001-1.007,P=0.015)and ADC(OR=1.041,95%CI:1.008-1.072,P=0.047)values were independent f

关 键 词：胶质瘤 磁共振成像 集成磁共振成像 扩散加权成像 O^(6)-甲基鸟嘌呤-DNA甲基转移酶 甲基化 预测 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.264[医药卫生—诊断学]