Kanazawa Tokunori, Fujiwara Hirokazu, Takahashi Hidenori, Nishiyama Yuya, Hirose Yuichi, Tanaka Saeko, Yoshida Kazunari, Sasaki Hikaru
Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Neurosurg Rev. 2019 Jun;42(2):433-441. doi: 10.1007/s10143-018-0981-x. Epub 2018 Apr 26.
Recent advance in molecular characterization of gliomas showed that patient prognosis and/or tumor chemosensitivity correlate with certain molecular signatures; however, this information is available only after tumor resection. If molecular information is available by routine radiological examinations, surgical strategy as well as overall treatment strategy could be designed preoperatively.With the aim to establish an imaging scoring system for preoperative diagnosis of molecular status in lower-grade gliomas (WHO grade 2 or 3, LrGGs), we investigated 8 imaging features available on routine CT and MRI in 45 LGGs (discovery cohort) and compared them with the status of 1p/19q codeletion, IDH mutations, and MGMT promoter methylation. The scoring systems were established based on the imaging features significantly associated with each molecular signature, and were tested in the another 52 LrGGs (validation cohort).For prediction of 1p/19q codeletion, the scoring system is composed of calcification, indistinct tumor border on T1, paramagnetic susceptibility effect on T1, and cystic component on FLAIR. For prediction of MGMT promoter methylation, the scoring system is composed of indistinct tumor border, surface localization (FLAIR), and cystic component. The scoring system for prediction of IDH status was not established. The 1p/19q score ≥ 3 showed PPV of 96.2% and specificity of 98.1%, and the MGMT methylation score ≥ 2 showed PPV of 77.4% and specificity of 67.6% in the entire cohort.These scoring systems based on widely available imaging information may help to preoperatively design personalized treatment in patients with LrGG.
胶质瘤分子特征的最新进展表明，患者预后和/或肿瘤化疗敏感性与某些分子特征相关；然而，此信息仅在肿瘤切除后才能获得。如果通过常规放射学检查能够获得分子信息，那么术前就可以设计手术策略以及整体治疗策略。为了建立一种用于术前诊断低级别胶质瘤（世界卫生组织2级或3级，LrGGs）分子状态的影像评分系统，我们在45例LGGs（发现队列）中研究了常规CT和MRI上可用的8种影像特征，并将它们与1p/19q共缺失、异柠檬酸脱氢酶（IDH）突变以及O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化状态进行比较。基于与每个分子特征显著相关的影像特征建立了评分系统，并在另外52例LrGGs（验证队列）中进行了测试。对于1p/19q共缺失的预测，评分系统由钙化、T1加权像上肿瘤边界不清、T1加权像上的顺磁敏感性效应以及液体衰减反转恢复序列（FLAIR）上的囊性成分组成。对于MGMT启动子甲基化的预测，评分系统由肿瘤边界不清、表面定位（FLAIR）以及囊性成分组成。未建立用于预测IDH状态的评分系统。在整个队列中，1p/19q评分≥3显示阳性预测值（PPV）为96.2%，特异性为98.1%，MGMT甲基化评分≥2显示PPV为77.4%，特异性为67.6%。这些基于广泛可用影像信息的评分系统可能有助于术前为LrGG患者设计个性化治疗方案。
