Zou Tianyu, Yu Hao, Jiang Chunxiu, Wang Xianlong, Jiang Shanshan, Rui Qihong, Mei Yingjie, Zhou Jinyuan, Wen Zhibo
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
NMR Biomed. 2018 Jan;31(1). doi: 10.1002/nbm.3850. Epub 2017 Nov 3.
The purpose of this work was to investigate the diagnostic performance of amide proton transfer-weighted (APTW) and intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the preoperative grading of gliomas. Fifty-one patients with suspected gliomas were recruited and underwent a preoperative MRI examination that included APTW and IVIM sequences. All cases were confirmed by postsurgical histopathology. APTW signal intensity, true diffusion coefficient (D), perfusion fraction (f) and pseudo-diffusion coefficient (D*) were applied to assess the solid tumor component and contralateral normal-appearing white matter. The relative APTW signal intensity (rAPTW) was also used. Independent-sample and paired-sample t-tests were used to compare differences in MRI parameters between low-grade glioma (LGG) and high-grade glioma (HGG) groups. The diagnostic performance was assessed with the receiver operating characteristic curve. Twenty-six patients were pathologically diagnosed with LGG and 25 were diagnosed with HGG. APTW, rAPTW and f values were significantly higher (all p < 0.001), whereas D values were significantly lower (p < 0.001) in the HGG group than in the LGG group. There was no significant difference between D* values for the two groups. rAPTW had an area under the curve (AUC) of 0.957, with a sensitivity of 100% and a specificity of 84.6%, followed by APTW, f, D and D*. The combined use of APTW and IVIM showed the best diagnostic performance, with an AUC of 0.986. In conclusion, APTW and IVIM, as two promising supplementary sequences for routine MRI, could be valuable in differentiating LGGs from HGGs.
本研究旨在探讨酰胺质子转移加权（APTW）和体素内不相干运动（IVIM）磁共振成像（MRI）在胶质瘤术前分级中的诊断效能。招募了51例疑似胶质瘤患者，术前行MRI检查，包括APTW和IVIM序列。所有病例均经术后组织病理学证实。应用APTW信号强度、真实扩散系数（D）、灌注分数（f）和伪扩散系数（D*）评估实性肿瘤成分及对侧外观正常的白质。还采用了相对APTW信号强度（rAPTW）。采用独立样本和配对样本t检验比较低级别胶质瘤（LGG）组和高级别胶质瘤（HGG）组MRI参数的差异。用受试者工作特征曲线评估诊断效能。26例患者经病理诊断为LGG，25例诊断为HGG。HGG组的APTW、rAPTW和f值显著高于LGG组（均p<0.001），而D值显著低于LGG组（p<0.001）。两组的D值无显著差异。rAPTW的曲线下面积（AUC）为0.957，敏感性为100%，特异性为84.6%，其次是APTW、f、D和D。APTW和IVIM联合使用显示出最佳诊断效能，AUC为0.986。总之，APTW和IVIM作为常规MRI的两种有前景的补充序列，在鉴别LGG和HGG方面可能具有重要价值。
