一体化^(18)F-FET PET/MR术前评估成人胶质瘤患者MGMT基因启动子甲基化状态  

Preoperative assessment of MGMT gene promoter methylation status in adult high-grade glioma patients by integrated ^(18)F-FET PET/MR

作　　者：韩青青 李拓 林增萍 李恩慧 杨阳 刘家惠 邢浩 王裕[4] 程欣[1] 霍力[1,5] HAN Qingqing;LI Tuo;LIN Zengping;LI Enhui;YANG Yang;LIU Jiahui;XING Hao;WANG Yu;CHENG Xin;HUO Li(Department of Nuclear Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Central Research Institute,United Imaging Healthcare Group Co.,Ltd.,Shanghai 201807,China;Beijing United Imaging Research Institute of Intelligent Imaging,Beijing 100094,China;Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院核医学科,北京100730 [2]上海联影医疗高新技术研究院有限公司,上海201807 [3]北京联影智能影像技术研究院,北京100094 [4]中国医学科学院北京协和医学院北京协和医院神经外科,北京100730 [5]核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《磁共振成像》2024年第7期21-26,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：北京协和医院中央高水平医院临床科研专项(编号:2022-PUMCH-A-019)。

摘　　要：目的 旨在研究一体化^(18)F-氟乙基酪氨酸(^(18)F-fluoroethyltyrosine, ^(18)F-FET)正电子发射断层成像(positron emission tomography, PET)/MR对成人胶质瘤的O6-甲基鸟嘌呤DNA甲基转移酶(O6-methylguanine DNA methyltransferase, MGMT)基因启动子甲基化状态的鉴别能力。材料与方法 回顾性分析未经活检或治疗的胶质瘤患者资料16例,均完成一体化PET/MR扫描,包括^(18)F-FET PET、常规MRI及体素内不相干运动(intravoxel incoherent motion, IVIM)成像。以靶本比(target-background ratio, TBR)=1.6为阈值对PET图像进行感兴趣体积(volume of interest, VOI)分割,通过刚性配准获得肿瘤VOI对应的IVIM图及其参数表观扩散系数(apparent diffusion coefficient, ADC)、真实扩散系数(true diffusion coefficient, D)、伪扩散系数(pseudo diffusion coefficient, D^(*))、灌注分数(perfusion fraction, f)、分布扩散系数(distributed diffusion coefficient, DDC)和异质性指数(heterogeneity index, α),使用pyradiomics对各参数进行特征提取,获得对应的一阶灰度直方图特征。计算每个IVIM参数图对应的特征值与^(18)F-FET PET参数的关系,并利用组间比较和受试者工作特征(receive operating characteristic, ROC)曲线分析探究PET和IVIM参数对MGMT启动子甲基化的区分能力。结果 IVIM-α的两个特征值90分位值(r=0.526,P<0.05)和最大值(r=0.520, P<0.05)与PET参数平均标准摄取值(meanstandarduptakevalue,SUVmean)呈正相关;IVIM-α和SUVmean在MGMT启动子甲基化状态阳性和阴性两组之间的差异有统计学意义(P<0.05),阳性组的IVIM-α均值和SUVmean显著高于阴性组;融合IVIM-α均值和SUVmean对MGMT启动子甲基化状态进行区分的曲线下面积(area under the curve, AUC)为0.77。结论 基于一体化PET/MR的^(18)F-FET PET和IVIM参数能够有效预测胶质瘤的MGMT启动子甲基化状态。Objective:To investigate the discriminative ability of integrated ^(18)F-fluoroethyltyrosine(^(18)F-FET)positron emission tomography(PET)/MR for O6-methylguanine DNA methyltransferase(MGMT)gene promoter methylation status in adult gliomas.Materials and Methods:A total of 16 patients with unbiopsied or untreated gliomas were retrospectively enrolled to complete integrated PET/MR scans,including ^(18)F-FET PET,conventional MRI and intravoxel incoherent motion(IVIM)imaging.The volume of interest(VOI)segmentation of PET images was performed using target-background ratio(TBR)=1.6 as a threshold,and IVIM maps corresponding to tumor VOI and their parameters,apparent diffusion coefficient(ADC),true diffusion coefficient(D),pseudo diffusion coefficient(D^(*)),perfusion fraction(f),distributed diffusion coefficient(DDC),and heterogeneity index(α),were obtained by rigid alignment,and the corresponding first-order gray-scale histogram features were obtained by feature extraction of each parameter using pyradiomics.The eigenvalues corresponding to each IVIM parameter map were calculated in relation to the ^(18)F-FET PET parameters,and the ability of PET and IVIM parameters to discriminate MGMT promoter methylation was explored using between-group comparisons and receiver operating characteristic(ROC)curve analysis.Results:The two eigenvalues 90th percentile(r=0.526,P<0.05)and maximum(r=0.520,P<0.05)of IVIM-αwere positively correlated with mean standard uptake value(SUVmean)of PET parameter;The differences between IVIM-αand SUVmean in the two groups of positive and negative MGMT promoter methylation status were statistically significant(P<0.05),and the positive group had significantly higher mean IVIM-αand SUVmean than the negative group.The area under the curve(AUC)of discrimination of the methylation status of the MGMT promoter by incorporating the mean IVIM-αvalue and SUVmean was 0.77.Conclusions:^(18)F-FET PET and IVIM parameters based on integrated PET/MR can effectively predict MGMT promoter methylation status in gl

关 键 词：胶质瘤 O6-甲基鸟嘌呤-DNA甲基转移酶启动子甲基化 ^(18)F-氟乙基酪氨酸正电子发射断层成像 正电子发射断层成像/磁共振 体素内不相干运动 磁共振成像 

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] R817.4[医药卫生—临床医学]