DKI、IVIM结合临床及常规MRI特征预测胶质瘤IDH1及1p/19q分子分型的价值  

The Value of DKI and IVIM Combined with Clinical and Conventional MRI Features in Predicting Glioma IDH1 and 1p/19q Molecular typing

作　　者：王萍 黄欢 武超颖 廖大伟 陈光祥 WANG Ping;HUANG Huan;WU Chaoying(Department of Radiology,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan Province 646000,P.R.China)

机构地区：[1]西南医科大学附属医院放射科,泸州646000 [2]西南医科大学附属中医医院磁共振室,泸州646000

出　　处：《临床放射学杂志》2025年第1期33-40,共8页Journal of Clinical Radiology

基　　金：四川省科技计划资助项目(编号:2022YFS0616)。

摘　　要：目的探讨磁共振扩散峰度成像(DKI)、体素内不相干运动(IVIM)结合临床及常规MRI特征预测胶质瘤异柠檬酸脱氢酶1(IDH1)及1p/19q分子分型的价值。方法搜集行MRI常规、DKI、IVIM扫描且经手术病理证实的61例胶质瘤患者,按病理结果将其分为3种亚型:IDH1突变不伴1p/19q共缺失型(IDH1mut-NonCodel),IDH1突变伴1p/19q共缺失型(IDH1mut-Codel),IDH1野生型(IDH1wt)。比较IDH1mut组与IDH1wt组、3种亚型间临床资料、常规MRI特征、相对平均扩散系数(rMD)、相对平均扩散峰度(rMK)、相对径向峰度(rKr)、相对轴向峰度(rKa)、相对各向异性分数(rFA)、相对伪扩散系数(rD)、相对真扩散系数(rD)、相对灌注分数(rf)的差异。绘制受试者工作特征(ROC)曲线,计算并比较曲线下面积(AUC)、敏感度、特异度。结果病灶部位、边界、T 2-FLAIR不匹配征(T 2FM)、扩散受限、强化、rMD、rMK、rD值在3种亚型间差异有统计学意义(P<0.05);部位、边界、强化、rMD、rMK、rD值在IDH1mut-Codel组与IDH1wt组间差异有统计学意义,边界、T 2FM、rMK在IDH1mut-NonCodel组与IDH1wt组间差异有统计学意义(P<0.05);部位、边界、rMD、rMK、rD、rD值在IDH1mut-Codel组与IDH1mut-NonCodel+IDH1wt组间差异有统计学意义,年龄、部位、边界、T 2FM、扩散受限、强化、rMD、rMK、rKr、rKa、rD、rD值在IDH1mut组与IDH1wt组间差异有统计学意义(P<0.05)。DKI及IVIM各参数单独诊断IDH1基因型、IDH1mut-Codel时,rMK的诊断效能最高,AUC值分别为0.799、0.784,敏感度分别为63.2%、100.0%,特异度分别为88.1%、62.7%,联合年龄、常规MRI特征、DKI、IVIM诊断IDH1基因型时,AUC值为0.962,敏感度和特异度分别为84.2%和97.6%,联合常规MRI特征、DKI、IVIM诊断IDH1mut-Codel时,AUC值为0.914,敏感度和特异度分别为90.0%和92.2%。结论DKI及IVIM结合临床及常规MRI特征有助于预测胶质瘤IDH1、1p/19q分子分型,能为胶质瘤患者的诊断、个体化治疗及预后�Objective To investigate the value of diffusion kurtosis imaging(DKI)and intravoxel incoherent motion(IVIM)combined with clinical and conventional MRI features in the prediction of isocitrate dehydrogenase 1(IDH1)and 1p/19q molecular types of glioma.Methods The data of sixty-one patients with glioma confirmed by surgical pathology who underwent conventional magnetic resonance,DKI and IVIM scans were collected.According to the pathological results,the glioma patients were divided into three subtypes:IDH1 mutation and no 1p/19q codeletion(IDH1mut-NonCodel),IDH1 mutation and 1p/19q codeletion(IDH1mut-Codel),and IDH1 wild type(IDH1wt).The differences in the clinical data,conventional MRI features,relative mean diffusion coefficient(rMD),relative mean kurtosis(rMK),relative radial kurtosis(rKr),relative axial kurtosis(rKa),relative fractional anisotropy(rFA),relative pseudo-diffusion coefficient(rD),relative true diffusion coefficient(rD)and relative perfusion fraction(rf)between IDH1mut and IDH1wt groups and also among the three subtypes were compared.Receiver operating characteristic(ROC)curves were drawn,and the areas under the curve(AUCs),sensitivities and specificities were calculated and compared.Results Lesion location,boundary,T 2-FLAIR mismatch sign(T 2FM),diffusion restriction,enhancement,rMD,rMK and rD differed significantly among the three subtypes(P<0.05);pairwise comparisons revealed significant differences in location,boundary,enhancement,rMD,rMK and rD between IDH1mut-Codel and IDH1wt groups,and significant differences in boundary,T 2FM and rMK between IDH1mut-NonCodel and IDH1wt groups(P<0.05).There were significant differences in location,boundary,rMD,rMK,rD and rD between IDH1mut-Codel and IDH1mut-NonCodel and IDH1wt groups,and significant differences in age,location,boundary,T 2FM,diffusion restriction,enhancement,rMD,rMK,rKr,rKa,rD and rD between IDH1mut and IDH1wt groups(P<0.05).When DKI and IVIM were used for individual diagnoses of the IDH1 genotype and IDH1mut-Codel,the rMK had the highest dia

关 键 词：胶质瘤 异柠檬酸脱氢酶 1p/19q 体素内不相干运动 扩散峰度成像 

分 类 号：R739.4[医药卫生—肿瘤] R445.2[医药卫生—临床医学]