3D-APTw及ADC直方图分析预测IDH突变型WHO 2/3级胶质瘤中ATRX基因突变的价值研究  

Histogram analysis based on 3D-amide proton transfer weighted and apparent diffusion coefficient imaging in predicting ATRX mutation in IDH-mutant WHO grading 2/3 gliomas

作　　者：邹霞 严欣然 李榆欣 屈耀铭 文海涛 马安东 张世忠[2] 温志波[1] Zou Xia;Yan Xinran;Li Yuxin;Qu Yaoming;Wen Haitao;Ma Andong;Zhang Shizhong;Wen Zhibo(Department of Imaging Diagnosis,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China;Department of Functional Neurosurgery,Neurosurgery Center,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院影像诊断科,广州510282 [2]南方医科大学珠江医院神经外科中心功能神经外科,广州510282

出　　处：《中华神经医学杂志》2024年第7期659-668,共10页Chinese Journal of Neuromedicine

基　　金：广州地区临床高新、重大、特色技术项目(2023P-TS44)。

摘　　要：目的评估3D-酰胺质子转移加权成像(APTw)、表观扩散系数(ADC)直方图分析预测异柠檬酸脱氢酶(IDH)突变型WHO 2/3级胶质瘤中α地中海贫血伴智力低下综合征X连锁(ATRX)基因突变的价值。方法选择自2017年6月至2023年10月于南方医科大学珠江医院神经外科中心功能神经外科就诊并经手术病理确诊的78例IDH突变型WHO 2/3级胶质瘤患者为研究对象,其中52例为ATRX野生型,26例为ATRX突变型。收集患者术前3D-APTw、ADC图像资料,经后处理后分别采用基于包含瘤周水肿的病灶勾画方式以及基于肿瘤实体的病灶勾画方式对病灶进行分割,之后分别从3D-APTw及ADC图像中提取直方图特征(10百分位数、90百分位数、最大值、平均值、中位数、最小值、偏度、峰度、熵、全距、均匀性和方差)。采用单因素分析比较ATRX突变型组与ATRX野生型组患者间各直方图特征的差异,采用多因素Logistic回归分析筛选ATRX基因突变的独立预测因子并用独立预测因子构建Logistic回归预测模型。采用受试者工作特征(ROC)曲线评估各独立预测因子及Logistic回归预测模型对ATRX基因突变的预测价值。结果(1)基于包含瘤周水肿的病灶勾画方式时,单因素分析示ATRX突变型组与ATRX野生型组患者间相对3D-APTw最小值、3D-APTw偏度、相对ADC 90百分位数、相对ADC平均值、相对ADC中位数、ADC峰度、ADC偏度、ADC均匀性及ADC熵的差异均有统计学意义(P<0.05)。基于肿瘤实体的病灶勾画方式时,单因素分析示ATRX突变型组与ATRX野生型组患者间相对3D-APTw 90百分位数、3D-APTw偏度、相对ADC 90百分位数、相对ADC平均值、相对ADC中位数、ADC峰度、ADC偏度、ADC均匀性及ADC熵的差异均有统计学意义(P<0.05)。(2)基于包含瘤周水肿的病灶勾画方式时,多因素Logistic回归分析示3D-APTw偏度及ADC峰度为IDH突变型WHO 2/3级胶质瘤患者中ATRX基因突变的独立预测因子(OR=Objective To evaluate the role of histogram analysis based on amide proton transfer weighted(APTw)and apparent diffusion coefficient(ADC)imaging in predicting alpha-thalassemia/mental retardation syndrome X-linked(ATRX)mutation in isocitrate dehydrogenase(IDH)-mutant WHO grading 2/3 gliomas.Methods Seventy-eight patients with IDH-mutant WHO grading 2/3 gliomas,admitted to and confirmed by surgical pathology in Department of Functional Neurosurgery,Neurosurgery Center,Zhujiang Hospital,Southern Medical University from June 2017 to October 2023,including 52 with ATRX wild and 26 with ATRX mutant-type,were selected.Preoperative 3D-APTw and ADC imaging data were collected;after post-processing,the lesions were segmented using lesion outlining method based on inclusion of peri-tumor edema and lesion outlining method based on tumor entity,respectively;after that,the histogram features(the 10 th percentile,90 th percentile,maximum,mean,median,minimum,skewness,kurtosis,entropy,range,uniformity,and variance)were extracted from 3D-APTw and ADC imaging,respectively.Univariate Logistic regression was used to compare the differences in histogram features between patients in the ATRX mutant group and ATRX wild-type group,and multivariate Logistic regression was used to screen the independent predictors for ATRX mutation(a Logistic regression prediction model was constructed).Predictive values of independent predictors and Logistic regression prediction models in ATRX mutation were evaluated by receiver operating characteristic(ROC)curve.Results(1)With lesion outlining method based on inclusion of peri-tumor edema,univariate analysis indicated significant difference between ATRX mutant group and ATRX wild-type group in 9 histogram features:relative 3D-APTw minimum,3D-APTw skewness,relative ADC 90 th percentile,relative ADC mean,relative ADC median,ADC kurtosis,ADC skewness,ADC uniformity,and ADC entropy(P<0.05).With lesion outlining method based on tumor entity,univariate analysis indicated significant difference between ATRX m

关 键 词：神经胶质瘤 酰胺质子转移加权成像 表观扩散系数 直方图分析 α地中海贫血伴智力低下综合征X连锁基因 异柠檬酸脱氢酶 

分 类 号：R739.4[医药卫生—肿瘤]