Lasocki Arian, Gaillard Frank, Tacey Mark, Drummond Katharine, Stuckey Stephen
Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Monash Imaging, Monash Health, Clayton, Victoria, Australia; Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Radiology, The University of Melbourne, Parkville, Victoria, Australia.
J Clin Neurosci. 2018 Jan;47:168-173. doi: 10.1016/j.jocn.2017.09.007. Epub 2017 Oct 5.
Glioblastomas with a substantial proportion of noncontrast-enhancing tumour (nCET) have a variety of imaging appearances. We aimed to determine whether glioblastomas demonstrating a substantial proportion (>33%) of nCET can be sub-classified by different morphologic pattern of nCET. We then assessed whether this improves the ability of MRI to predict isocitrate dehydrogenase-1 (IDH1) mutation status and whether this has prognostic significance independent of IDH1 mutation status. Pre-operative MRIs of patients with a new diagnosis of glioblastoma were reviewed. Tumours with >33% nCET were sub-classified by the dominant morphologic pattern of nCET: mass-like expansion, white matter dissemination, grey matter dissemination or a combination. IDH1 mutation status (by immunohistochemistry) and survival were compared for each pattern. 153 patients met the inclusion criteria, of whom 34 patients demonstrated >33% nCET. 10 patients had a significant mass-like component, either as the dominant pattern (n=4) or as part of a mixed pattern (n=6). The 10 patients with a significant mass-like component had longer survival than those without (median 387days, compared to 241days), though this was not statistically significant (p=0.242). Three patients had R132H-IDH1 mutations and >33% nCET, and all three had a mass-like component. Using the presence of a mass-like component of nCET for predicting IDH1 mutation status improved the positive predictive value, specificity and overall accuracy of MRI. Classification of nCET by morphologic pattern improves the ability of MRI to predict IDH1 mutations and may provide useful prognostic information.
具有相当比例非增强肿瘤（nCET）的胶质母细胞瘤有多种影像学表现。我们旨在确定显示相当比例（>33%）nCET的胶质母细胞瘤是否可根据nCET的不同形态学模式进行亚分类。然后，我们评估这是否提高了MRI预测异柠檬酸脱氢酶-1（IDH1）突变状态的能力，以及这是否具有独立于IDH1突变状态的预后意义。对新诊断为胶质母细胞瘤患者的术前MRI进行了回顾。nCET>33%的肿瘤根据nCET的主要形态学模式进行亚分类：肿块样扩张、白质扩散、灰质扩散或混合模式。比较每种模式的IDH1突变状态（通过免疫组织化学）和生存率。153例患者符合纳入标准，其中34例患者显示nCET>33%。10例患者有明显的肿块样成分，要么作为主要模式（n=4），要么作为混合模式的一部分（n=6）。10例有明显肿块样成分的患者比没有的患者生存期更长（中位数387天，而无肿块样成分的患者为241天），尽管这在统计学上无显著差异（p=0.242）。3例患者有R132H-IDH1突变且nCET>33%，且这3例均有肿块样成分。利用nCET的肿块样成分预测IDH1突变状态提高了MRI的阳性预测值、特异性和总体准确性。根据形态学模式对nCET进行分类可提高MRI预测IDH1突变的能力，并可能提供有用的预后信息。
