IDH突变型4级星形细胞瘤与GBM进展的MRI征象比较及其对预后影响分析  

MRI features of tumor progression and their impact on survival outcome:a comparative study between IDH mutant grade 4 astrocytoma and GBM

作　　者：王聪惠 袁涛[1] 娄蕾[2] 高丽娟[1] 田磊[3] 全冠民[1] WANG Cong-hui;YUAN Tao;LOU Lei(Department of Medical Imaging,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院影像科,石家庄050000 [2]河北医科大学第二医院病理科,石家庄050000 [3]河北医科大学第二医院放疗科,石家庄050000 [4]江苏省镇江市第一人民医院,江苏212002

出　　处：《放射学实践》2025年第1期47-54,共8页Radiologic Practice

基　　金：河北省政府资助学科带头人项目(361004)。

摘　　要：目的:探讨异柠檬酸脱氢酶(IDH)突变型4级星形细胞瘤(IDHmut-Astro-4)与胶质母细胞瘤(GBM)进展影像指标的差异,进而分析这种差异及其相关的临床和病理因素对两种肿瘤不良生存预后的影响。方法:回顾性分析经病理证实并出现进展的14例IDHmut-Astro-4和32例GBM患者的临床和MRI资料,比较两者进展的MRI征象、临床及病理学指标的差异,影像学征象包括强化形态、强化及液体衰减反转恢复序列(FLAIR)高信号区正交值增大、新增远处强化、新增室管膜下强化、相对表观扩散系数(rADC)、相对脑血容量(rCBV)、相对脑血流量(rCBF)、胆碱(Cho)与N-乙酰天冬氨酸(NAA)比值。采用Cox比例风险回归模型分析影响两者生存的因素。结果:与IDHmut-Astro-4相比,GBM患者年龄较大(>54岁)(P<0.001)、肿瘤常在额叶之外(P<0.001)、1号染色体短臂及19号染色体长臂(1p19q)未缺失率较高(P=0.010)、端粒酶逆转录酶启动子(pTERT)突变型占比较高(P=0.001)、无进展生存期(PFS)(P=0.014)及生存期(OS)(P=0.009)较短、肿瘤进展残腔壁强化形态趋向于肿块状(P=0.034)、残腔外FLAIR高信号正交值增加较大(P=0.044)、rCBV(P=0.020)较高。多因素森林图表明,年龄(>51岁)、pTERT突变、肿瘤进展肿块状强化、rCBV(>1.68)预测OS的风险比(HR)值分别为1.00、2.21、1.79、3.65。结论:IDHmut-Astro-4与GBM进展的MRI征象有一定差异,GBM侵袭性征象更明显,以rCBV为著,并可部分解释GBM生存预后较差的原因;提示IDHmut-Astro-4与GBM的生存差异部分原因是两者的血管生成程度不同,这可能为临床制定治疗方案(特别是抗血管生成)提供引导。Objective:To explore the difference of imaging features of progressive lesions between isocitrate dehydrogenase(IDH)mutant grade 4 astrocytoma(IDHmut-Astro-4)and glioblastoma(GBM),and to assess the impact of these differences along with related clinical and pathological factors on the unfavorable survival outcome of these tumors.Methods:A retrospective analysis was conducted on the clinical and MRI data of 14 patients with IDHmut-Astro-4 and 32 patients with GBM,both confirmed by pathology.The differences in MRI features of progressive lesions,as well as clinical and pathological factors between the two tumor types,were compared.The analyzed MRI features included the enhancement pattern,changes in orthogonal values of enhancement on post-contrast T 1-weighted imaging(T 1WI),hyperintensity on fluid-attenuated inversion recovery sequence(FLAIR),newly appearing lesions with enhancement in distant and subventricular regions,relative apparent diffusion coefficient(rADC),relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),and the ratio of choline(Cho)to N-acetylaspartate(NAA).Cox proportional hazards regression was employed to identify key factors affecting the survival of the patients with IDHmut-Astro-4 and GBM.Results:Compared to the IDHmut-Astro-4,GBM patients significantly older(mean age>54 years)(P<0.001),with tumors more frequently located outside the frontal lobe(P<0.001).They had a higher incidence of non-deletion of the short arm of chromosome 1 and the long arm of chromosome 19(1p19q)(P=0.010),a higher prevalence of telomerase reverse transcriptase(pTERT)mutations(P=0.001),and significantly shorter progression-free survival(PFS)(P=0.014)and overall survival(OS)(P=0.009).The GBM group also showed a significantly higher proportion of residual wall enhancement in a massive pattern(P=0.034),a larger increase in the FLAIR high signal orthogonal value outside the residual cavity(P=0.044),and a higher rCBV(P=0.020).Multivariate analysis indicated that older age(>51 years),pTERT mutation,massive

关 键 词：胶质母细胞瘤 IDH突变型4级星形细胞瘤 磁共振成像 进展 预后 

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