全容积合成MRI联合3D-ASL直方图预测胶质瘤MGMT启动子甲基化状态的价值研究  

Whole-tumor histogram analysis of synthetic MRI and 3D-ASL in predicting the expression of MGMT promoter methylation in glioma

作　　者：党佩 王立东 葛鑫 黄雪莹[1] 侯明丽 李敏 王晓东[1] DANG Pei;WANG Li-dong;GE Xin(Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院放射科,银川750004 [2]宁夏银川市中医医院放射科,银川750004 [3]甘肃省兰州市兰州大学第二临床医学院,兰州730030 [4]通用电气医疗(中国)磁共振部,北京100176

出　　处：《放射学实践》2024年第6期733-740,共8页Radiologic Practice

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

摘　　要：目的:探讨全容积合成MRI联合3D-ASL直方图术前无创预测胶质瘤MGMT启动子甲基化状态的临床价值。方法:回顾性将2020年8月至2022年8月在本院行颅脑合成MRI和3D-ASL序列扫描且术后病理证实的50例胶质瘤患者纳入研究。由2名放射科医师使用3D-Slicer软件勾画肿瘤全容积后分别提取合成MRI和3D-ASL的定量参数T1、T2、PD及CBF的直方图特征(10th位数、90th位数、均值、熵、峰度、偏度)。根据MGMT启动子甲基化表达状态将胶质瘤患者分为甲基化组与非甲基化组。比较2名观察者测量各参数值的一致性差异;采用独立样本t检验或Mann-Whitney U检验比较甲基化组与未甲基化组各定量参数的直方图特征差异;采用ROC和二分类logistic回归分析各参数及其联合的诊断效能,计算ROC曲线下面积(area under the curve,AUC),选择约登指数并确定最佳截断值及其鉴别诊断的灵敏度及特异度。采用Spearman相关分析研究各参数值与MGMT启动子甲基化的相关性。以P<0.05为差异有统计学意义。结果:2名观察者测量各参数值的一致性均较好(ICC>0.80)。MGMT启动子甲基化组的T1-10th位数(613.36±118.01)、T2-10th位数(63.70±5.88)及CBF-熵值[0.77(0.72,0.90)]均低于MGMT启动子非甲基化组[分别为843.42±87.67、68.92±5.34、1.21(1.02,1.39)],差异具有统计学意义(分别为t=7.77、t=3.27、Z=5.37,P均<0.05),多因素logistic回归分析显示T1-10th位数[OR=1.013,95%CI(1.002~1.025),P=0.02]、T2-10th位数[OR=1.081,95%CI(0.905~1.292),P=0.038]、CBF-熵值[OR=1.007,95%CI(2.795~3.631),P=0.027]值是预测胶质瘤MGMT甲基化的独立影响因素,且其与MGMT启动子甲基化表达状态均呈负相关(r分别为-0.724、-0.409、-0.767,P<0.01)。ROC显示T1-10th位数、T2-10th位数、CBF-熵值鉴别MGMT启动子甲基化组与MGMT启动子非甲基化组的曲线下面积(AUC)分别为0.918、0.736、0.913。多参数分析中三者联合的诊断效能最高(AUC=0.973),灵敏度和�Objective:To explore the clinical value of preoperative noninvasive prediction of MGMT promoter methylation status in glioma using whole-volume synthetic MRI combined with 3D-ASL histogram analysis.Methods:50 postoperative pathological identified glioma patients were retrospective enrolled and underwent MRI scanning in our hospital from August 2020 to August 2022 and were confirmed by.Two radiologists used 3D-slicer software to delineate the entire tumor volume and extract histogram features of the quantitative parameters T1,T2,PD,and CBF from synthetic MRI and 3D-ASL,including the 10 th,90 th percentile,mean,entropy,kurtosis,and skewness.All patients were divided into methylated and unmethylated groups based on MGMT promoter methylation status.The consistency of parameter values measured by the two observers was compared,and the histogram feature differences of each quantitative parameter in the methylated and unmethylated groups were analyzed using independent sample t-tests or Mann-Whitney U tests.ROC and dichotomous logistic regression analyses were used to evaluate the diagnostic performance of each parameter and their combination,calculate the area under the ROC curve(AUC),select the Jorden index,and determine the optimal cut-off value along with sensitivity and specificity for differential diagnosis.Spearman correlation analysis was performed to study the correlation between parameter values and MGMT promoter methylation status.A P-value of less than 0.05 was considered statistically significant.Results:The consistency of the parameter values measured by the two observers was good(ICC>0.80).The T1-10th percentile(613.36±118.01),T2-10th percentile(63.70±5.88),and CBF-entropy[0.77(0.72,0.90)]of the MGMT promoter methylated group were lower than those of the non-methylated group[843.42±87.67,68.92±5.34,1.21(1.02,1.39),respectively],and the differences were statistically significant(t=7.77,t=3.27,Z=5.37,P<0.05).Multivariate logistic regression analysis showed that T1-10th percentile[OR=1.013,95%CI(1.002~1.

关 键 词：胶质神经瘤 磁共振成像 自旋标记物 

分 类 号：R730.264[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R916.4