2-羟戊二酸磁共振波谱在异柠檬酸脱氢酶野生型胶质母细胞瘤中假阳性测量：多因素分析。
False-Positive Measurement at 2-Hydroxyglutarate MR Spectroscopy in Isocitrate Dehydrogenase Wild-Type Glioblastoma: A Multifactorial Analysis.
机构信息
From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 05505, Republic of Korea (C.H.S., H.S.K., D.K., J.E.P., S.C.J., C.G.C., S.J.K.); Department of Radiology, Gangneung Asan Hospital, Gangneung, Republic of Korea (W.P.); Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (C.C.); Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea (K.H.R.); and Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea (D.C.W.).
出版信息
Radiology. 2019 Jun;291(3):752-762. doi: 10.1148/radiol.2019182200. Epub 2019 Apr 16.
Background Isocitrate dehydrogenase (IDH) mutation has become one of the most important prognostic biomarkers in glioma management. Measurement of 2-hydroxyglutarate (2HG) with MR spectroscopy has shown high pooled sensitivity, although false-positive results with MR spectroscopy have been reported. Purpose To investigate factors associated with false-positive 2HG measurements at MR spectroscopy in patients with IDH wild-type glioblastoma. Materials and Methods This retrospective study was approved by the institutional review board, and informed consent was waived. Consecutive patients with histopathologically confirmed pre- and posttreatment glioblastoma were evaluated between December 2017 and August 2018. Spectroscopy parameters, including 2HG measurements, were obtained with single-voxel point-resolved spectroscopy, and apparent diffusion coefficient (ADC) values were calculated. Necrosis was graded according to the proportion of necrosis within a volume of interest. Poisson regression analyses were performed to determine factors related to false-positive 2HG measurements. Results A total of 82 patients were included (mean age, 55 years ± 12 [standard deviation]; 40 men). The 2HG measurement showed a false-positive rate of 21% (17 of 82; 95% CI: 13%, 31%) in patients with IDH wild-type glioblastoma. Multivariable analysis revealed that necrosis (prevalence ratio [PR], 3.9; 95% CI: 1.6, 9.4; = .01) and ADC value (PR, 0.1 × 10 mm/sec; 95% CI: [0.0, 0.7] × 10 mm/sec; = .02) were associated with a greater false-positive rate for the 2HG measurement. Necrosis of more than 20% was associated with a higher rate of false-positive 2HG measurements (50%) than was necrosis of 20% or less (15%, = .01). The 2HG false-positive rate was higher in patients with pretreatment glioblastoma (46%) than in those with posttreatment glioblastoma (14%, < .01). Among 17 patients with false-positive findings, 15 (88%; 95% CI: 64%, 99%) had a lactate concentration of 2.0 mmol/L or higher, and 14 (82%, 95% CI: 57%, 96%) had a lactate concentration of 3.0 mmol/L or higher. Conclusion Necrosis and apparent diffusion coefficient were associated with false-positive measurements of 2-hydroxyglutarate at MR spectroscopy in patients with isocitrate dehydrogenase wild-type glioblastoma. © RSNA, 2019
背景 异柠檬酸脱氢酶（IDH）突变已成为胶质瘤管理中最重要的预后生物标志物之一。磁共振波谱测量 2-羟戊二酸（2HG）的方法具有较高的汇总敏感性，尽管已有报道称磁共振波谱存在假阳性结果。目的 旨在研究 IDH 野生型胶质母细胞瘤患者中磁共振波谱上出现假阳性 2HG 测量结果的相关因素。材料与方法 本回顾性研究经机构审查委员会批准，豁免了知情同意。2017 年 12 月至 2018 年 8 月，连续评估了经组织病理学证实的治疗前后胶质母细胞瘤患者。应用单体素点分辨波谱法获得波谱参数，包括 2HG 测量值，并计算表观扩散系数（ADC）值。根据感兴趣区内的坏死比例对坏死进行分级。采用泊松回归分析确定与假阳性 2HG 测量结果相关的因素。结果 共纳入 82 例患者（平均年龄，55 岁±12 岁[标准差]；40 例男性）。IDH 野生型胶质母细胞瘤患者的 2HG 测量值假阳性率为 21%（17/82；95%CI：13%，31%）。多变量分析显示，坏死（患病率比[PR]，3.9；95%CI：1.6，9.4；P =.01）和 ADC 值（PR，0.1×10 mm/sec；95%CI：[0.0，0.7]×10 mm/sec；P =.02）与 2HG 测量的假阳性率更高相关。坏死比例大于 20%的患者与坏死比例为 20%或更低（15%，P =.01）的患者相比，更易出现 2HG 假阳性测量结果（50%比 15%）。治疗前胶质母细胞瘤患者的 2HG 假阳性率（46%）高于治疗后患者（14%，P<.01）。在 17 例出现假阳性结果的患者中，15 例（88%；95%CI：64%，99%）的乳酸浓度为 2.0 mmol/L 或更高，14 例（82%；95%CI：57%，96%）的乳酸浓度为 3.0 mmol/L 或更高。结论 IDH 野生型胶质母细胞瘤患者中，磁共振波谱上的 2-羟戊二酸假阳性测量结果与坏死和表观扩散系数有关。
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