APT-联合DCE-MRI术前预测成人型弥漫性胶质瘤病理分级及IDH基因突变型  

Preoperative predicting the pathological grade and IDH gene mutation type of adult diffuse glioma by APT imaging combined with DCE-MRI

作　　者：陈世煌 黄日升[1] 林慧宇 丁增兴[3] 卢丽梅 CHEN Shi-huang;HUANG Ri-sheng;LIN Hui-yu(Department of Imaging,the First Hospital of Quanzhou Affiliated to Fujian Medical University,Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州市第一医院影像科,福建泉州362000 [2]福建医科大学附属泉州市第一医院放疗科,福建泉州362000 [3]泉州市儿童医院影像科,福建泉州362000

出　　处：《放射学实践》2024年第8期1021-1025,共5页Radiologic Practice

基　　金：福建省自然科学基金(2023J011772)。

摘　　要：目的:探讨氨基质子转移(APT)成像联合DCE-MRI对成人型弥漫性胶质瘤病理分级和IDH基因型的术前预测价值。方法:将2020年10月-2023年10月在本院诊治且经病理证实的78例脑胶质瘤患者纳入本研究。患者手术前均进行APT成像和DCE-MRI检查。依据肿瘤的组织病理学分级将患者分为2组:低级别组(Ⅱ~Ⅲ级)36例,高级别组(Ⅳ级)42例;依据患者IDH基因表达情况将患者分为2组:IDH野生型组31例,IDH突变型组47例。比较高、低病理分级组及不同IDH分型组之间病灶的APT图像信号等级(分为1~5级)和DCE-MRI参数(K_(trans)、V_(e)、rCBV、V_(p)、K_(ep)和rCBF)值的差异,对组间差异有统计学意义的指标,采用ROC曲线分析其诊断效能。结果:IDH突变型和野生型组之间年龄、性别、主诉、神经系统体征差异均无统计学意义(P>0.05);高级别组和低级别组之间年龄、性别、主诉、神经系统体征差异均无统计学意义(P>0.05),但是高级别组中IDH野生型占比更高(P<0.05)。78例病灶的APT信号分级:1级有19例,2级3例,3级14例,4级6例,5级36例。高级别组APT图像上肿瘤的信号等级高于低级别组,IDH野生型组患者APT图像等级高于突变型组,差异有统计学意义(P<0.05)。DCE-MRI参数的组间比较结果显示,高级别组与低级别组之间,以及IDH突变型与IDH野生型之间,K_(trans)、V_(e)和rCBV值的差异均有统计学意义(P<0.05)。APT信号等级鉴别高、低级别胶质瘤及IDH状态的AUC分别为0.782和0.714,K_(trans)、V_(e)和rCBV鉴别高、低级别胶质瘤的AUC分别为0.982、0.793和0.898,鉴别IDH状态的AUC分别为0.963、0.803和0.873。结论:APT成像联合DCE-MRI定量参数能在术前较准确地预测成人型弥漫性胶质瘤的病理分级和IDH基因分型。Objective:To study the value of amide proton transfer(APT)imaging combined with DCE-MRI in preoperative prediction of pathological grade and IDH genotype of adult diffuse glioma.Methods:A total of 78 patients with pathologically confirmed glioma treated in our hospital from October 2020 to October 2023 were included in this study.According to the histopathological grade of the glioma,the patients were divided into two groups:36 cases in low-grade group(Ⅱ~Ⅲgrade)and 42 cases in high-grade group(Ⅳgrade).According to the expression level of IDH gene,the patients were divided into two groups:31 cases in IDH mutant group and 47 cases in IDH wild-type group.All patients underwent APT imaging and DCE-MRI examination before surgery.The differences in APT image signal levels(divided into 1~5 levels)and the values of DCE-MRI parameters(K_(trans),V_(e),rCBV,V_(p),K_(ep)and rCBF)between high and low pathological grade groups and between different IDH typing groups,then ROC curve analysis was used to evaluate the diagnostic efficacy of indicators with statistically significant differences between groups.Results:There were no significant difference in neurological signs,chief compiaint,gender and age of the patients between the IDH mutant group and the wild-type group,and between the high-grade group and the low-grade group(all P>0.05),but the IDH mutation rate in the high-grade group was higher(P<0.05).Among the 78 patients,the tumor signal on APT images were grade 1 in 19 patients,grade 2 in 3 patients,grade 3 in 14 patients,grade 4 in 6 patients,and grade 5 in 36 patients.The signal grade on APT of the high-grade group was higher than that of the low-grade group,the similar result were also found between the IDH mutant group and wild-type group.The DCE-MRI parameters between the groups were compared,and there was significant difference in K_(trans),V_(e),and rCBV between the high-grade group and the low-grade group,and between the IDH mutant type and the IDH wild type(all P<0.05).The AUCs of APT grade for glioma patho

关 键 词：氨基质子转移成像 动态对比增强 磁共振成像 脑肿瘤 弥漫性胶质瘤 肿瘤分级 IDH基因型 

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]