常规MRI分形参数预测成人2~3级弥漫性胶质瘤IDH1突变状态的研究  

Study of conventional MRI fractal parameters in predicting IDH1 mutation status of adult grade 2-3 diffuse gliomas

作　　者：王玉瑶 张瑾 乔书琪 杨洋 胡玉川 颜林枫 崔光彬 WANG Yuyao;ZHANG Jin;QIAO Shuqi;YANG Yang;HU Yuchuan;YAN Linfeng;CUI Guangbin(Department of Radiology,The Second Affiliated Hospital of Air Force Military Medical University,Shaanxi 710038,China)

机构地区：[1]空军军医大学附属第二医院放射诊断科,陕西西安710038

出　　处：《影像诊断与介入放射学》2024年第2期120-127,共8页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金(82102127);空军军医大学第二附属医院青年自主创新科学基金(2023ATDQN014)。

摘　　要：目的评估常规MRI分形参数预测成人2~3级弥漫性胶质瘤异柠檬酸脱氢酶1(IDH1)突变状态的效能。方法回顾性分析我院2017年2月—2019年4月经手术及活检病理证实为2~3级弥漫性胶质瘤且IDH1突变状态明确的151例患者临床及影像资料,其中IDH1突变型(IDH1mut)118例,IDH1野生型(IDH1wt)33例。所有患者术前两周内采集平扫MRI。两名放射科医师基于液体衰减反转恢复(FLAIR)图像完成全肿瘤兴趣区勾画,利用Image J及FracLac插件提取该区域的分形维数(FD)及空隙度(LAC)参数,并采用Mann-Whitney U检验比较两组间分形参数差异。采用组内相关系数(ICC)评价两名医师提取定量参数的观察者内及观察者间一致性。二元Logistic回归用于构建联合参数(FD+LAC)诊断模型。利用受试者工作特征(ROC)曲线评价不同参数/模型诊断效能。不同参数/模型效能比较采用DeLong检验。结果FD、LAC参数的观察者内及观察者间一致性均较好(ICC均>0.8)。IDH1wt组FD值(1.274)及LAC值(0.434)中位数均高于IDH1mut组(FD:1.192;LAC:0.370),差异具有统计学意义(P均<0.001)。ROC分析结果显示,FD、LAC及联合参数模型(FD+LAC)在预测成人2~3级弥漫性胶质瘤IDH1突变状态曲线下面积为0.818、0.860、0.903,敏感度为0.780、0.822、0.805,特异度为0.818、0.788、0.849。结论基于常规MRI的分形分析参数有助于预测成人2~3级弥漫性胶质瘤IDH1突变状态。联合参数模型(FD+LAC)具有良好的诊断效能。Objective To evaluate the effectiveness of conventional MRI fractal parameters in predicting the isocitrate dehydrogenase 1(IDH1)mutation status of adult grade 2-3 diffuse gliomas.Methods A retrospective analysis of the clinical and MRI data was conducted from 151 patients with pathologically confirmed grade 2-3 diffuse gliomas and IDH1 mutation status of IDH1 mutant type(IDH1mut:118)and wild type(IDH1wt:33).The entire tumor region of interest(ROI)was delineated on the fluid attenuated inversion recovery(FLAIR)images by two radiologists independently.The fractal dimension(FD)and lacunarity(LAC)parameters of the ROI were extracted using Image J and FracLac plug-ins.Mann-Whitney U test was used to compare the differences of these parameters between the two groups.Intraclass correlation coefficient(ICC)was applied to evaluate the intra-observer and inter-observer consistency of quantitative parameters extracted by the two radiologists.Binary logistic regression was utilized to construct a combined parameter(FD+LAC)diagnostic model.The diagnostic efficacy of different parameters/models was analyzed using the receiver operating characteristic(ROC)curve.The DeLong test was performed to compare the efficacy of different parameters/models.Results Intra-and inter-observer reliability was good for FD and LAC parameters(both ICC>0.8).The median FD value(1.274)and LAC value(0.434)of IDH1wt group were both significantly(P<0.001)higher than those of IDH1mut group(FD:1.192;LAC:0.370).The areas under ROC curves of the IDH1 mutation status prediction were 0.818 with 78.0%sensitivity and 81.8%specificity for FD,0.860 with 82.2%sensitivity and 78.8%specificity for LAC,and 0.903 with 80.5%sensitivity and 84.9%specificity for FD+LAC.Conclusion Conventional MRI fractal analysis is useful for predicting IDH1 mutation status in grade 2-3 diffuse gliomas of adults.The combined parametric FD+LAC model shows greater diagnostic effectiveness compared to individual parameters.

关 键 词：磁共振成像 分形维数 空隙度 弥漫性胶质瘤 异柠檬酸脱氢酶1 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]