动脉自旋标记和扩散张量成像评估脑胶质瘤IDH1基因表型的价值研究  

Value of arterial spin labeling and diffusion tensor imaging in evaluating IDH1 gene phenotype in gliomas

作　　者：张萌[1,2] 耿瑞雯[1] 白源 董洋 ZHANG Meng;GENG Ruiwen;BAI Yuan;DONG Yang(Department of Radiology,the Second Hospital of Dalian Medical University,Dalian 116027,China;Dalian Medical University,Dalian 116027,China)

机构地区：[1]大连医科大学附属第二医院放射科,大连116027 [2]大连医科大学,大连116027

出　　处：《磁共振成像》2023年第10期58-64,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：辽宁省教育厅科研计划项目(编号:LZ2019030)。

摘　　要：目的 探讨常规MRI联合动脉自旋标记(arterial spin labeling,ASL)成像、扩散张量成像(diffusion tensor imaging,DTI)在评估胶质瘤异柠檬酸脱氢酶1(isocitrate dehydrogenase 1,IDH1)表型中的价值。材料与方法 回顾性分析2019年9月至2021年12月经病理证实为胶质瘤患者病例61例,根据基因或免疫组化检测IDH1表型,分为IDH1突变型(IDH1_(mutant),IDH1_(mut))组和IDH1野生型(IDH1 wild,IDH1_(wt))组,术前行颅脑MRI常规检查及ASL、DTI检查。评估IDH1_(mut)、IDH1_(wt)胶质瘤常规MRI特征(大小、位置、边缘、坏死囊变、出血、水肿和强化),测量肿瘤实性区、瘤周区的各向异性分数(anisotropy fraction,FA)、表观扩散系数(apparent diffusion coefficient,ADC)、脑血流量最大值(_(max)imum cerebral blood flow,CBF_(max))、平均值(_(mean) cerebral blood flow,CBF_(mean)),计算相对脑血流量最大值(relativer CBF_(max),r CBF_(max))、相对脑血流量平均值(relativer CBF_(mean),r CBF_(mean))。采用SPSS 25.0进行统计学分析。所有样本组间分析采用独立样本t检验或非参数检验进行分析,建立多因素logistic回归模型并绘制受试者工作特征(receiver operating characteristic,ROC)曲线预测其诊断效能。结果 本研究共纳入胶质瘤患者病例61例:IDH_(mut)19例、IDH1_(wt)42例。IDH1_(mut)与IDHwt胶质瘤的位置、强化、水肿、肿瘤实性区CBF、瘤周区ADC具有显著性差异(P<0.05);IDH1_(wt)肿瘤实性区CBF_(max)、CBF_(mean)、r CBF_(max)、r CBF_(mean)高于IDH1_(mut)型(P<0.05),曲线下面积(area under the curve,AUC)分别为0.879、0.832、0.806、0.875;IDH1_(wt)瘤周ADC值高于IDH1_(mut)(P<0.05)。肿瘤实质区CBF_(mean)联合瘤周ADC诊断IDH1表型的效能最高(AUC=0.892)。多因素logistic回归显示肿瘤实体区CBF是胶质瘤IDH1表型预测的独立风险因素。结论 常规MRI特征、ASL及DTI对胶质瘤IDH1表型评估具有重要临床价值,联合肿瘤实质区CBF、瘤周ADC值可进一步提高胶质瘤IObjective To investigate the value of conventional MRI combined with arterial spin labeling(ASL)imaging and diffusion tensor imaging(DTI)in assessing the phenotype of isocitrate dehydrogenase 1(IDH1)value in glioma.Materials and Methods:Sixty-one cases of patients with pathologically confirmed glioma from September 2019 to December 2021 were collected retrospectively and divided into IDH1_(mutant)(IDH1_(mut))and IDH1 wild(IDH1_(wt))groups according to IDH1 phenotype by genetic or immunohistochemical detection.Routine cranial MRI examination,ASL and DTI examination were performed before surgery.Evaluate the conventional MRI features of IDH1_(mut) and IDH1_(wt) gliomas(size,location,margin,necrotic cystic changes,hemorrhage,edema,and enhancement),measure the anisotropy fraction(FA),apparent diffusion coefficient(ADC),_(max)imum cerebral blood flow(CBF_(max))and _(mean)(CBF_(mean))of the solid tumor area and peritumor area,and the relative CBF_(max)(rCBF_(max)),relative cerebral CBF_(mean)(rCBF_(mean))were computed.Statistical analysis was performed using SPSS 25.0.All inter-sample analyses were performed using independent samples t-tests or non-parametric tests.Multi-factor logistic regression models were developed and receiver operating characteristic(ROC)curves were plotted to predict diagnostic efficacy.Results:A total of 61 cases of gliomas were included in this study:19 cases of IDH1_(mut) and 42 cases of IDH1_(wt).There were significant differences in the location,enhancement,edema,CBF in the solid tumor area,and ADC in the peritumor area between IDH1_(mut) and IDH1_(wt) gliomas(P<0.05).CBF_(max),CBF_(mean),rCBF_(max),and rCBF_(mean) in the solid tumor area of IDH1_(wt) were higher than those of IDH1_(mut)(P<0.05),and the area under the curve(AUC)was 0.879,0.832,0.806,0.875,respectively.The peritumoral ADC value of IDH1_(wt) was higher than that of IDH1_(mut)(P<0.05).The CBF_(mean) in solid tumor area combined with ADC value in peritumor area had the highest diagnostic efficacy(AUC=0.892).Multi-factor logisti

关 键 词：胶质瘤 磁共振成像 动脉自旋标记 扩散张量成像 异柠檬酸脱氢酶1 瘤周 

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]