H3K27M 突变型和野生型小儿弥漫性中线脑胶质瘤的高级 MRI 成像和 F-DOPA PET 特征。
Advanced MR imaging and F-DOPA PET characteristics of H3K27M-mutant and wild-type pediatric diffuse midline gliomas.
机构信息
Nuclear Medicine Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, via G. Gaslini 5, 16147, Genoa, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Jul;46(8):1685-1694. doi: 10.1007/s00259-019-04333-4. Epub 2019 Apr 27.
PURPOSE
The aim of this study was to investigate MRI-derived diffusion weighted imaging (DWI), H-MR spectroscopy (H-MRS) and arterial spin labeling (ASL) perfusion imaging in comparison with F-dihydroxyphenylalanine (DOPA) PET with respect to diagnostic evaluation of pediatric diffuse midline gliomas (DMG) H3K27M-mutant and wild-type.
METHODS
We retrospectively analyzed 22 pediatric patients with DMG histologically proved and molecularly classified as H3K27M-mutant (12 subjects) and wild-type (10 subjects) who underwent DWI, H-MRS, and ASL performed within 2 weeks of F-DOPA PET. DWI-derived relative minimum apparent diffusion coefficient (rADC min), H-MRS data [choline/N-acetylaspartate (Cho/NAA), choline/creatine (Cho/Cr), and presence of lactate] and relative ASL-derived cerebral blood flow max (rCBF max) were compared with F-DOPA uptake Tumor/Normal tissue (T/N) and Tumor/Striatum (T/S) ratios, and correlated with histological and molecular features of DMG. Statistics included Pearson's chi-square and Mann-Whitney U tests, Spearman's rank correlation and receiver operating characteristic (ROC) analysis.
RESULTS
The highest degrees of correlation among different techniques were found between T/S, rADC min and Cho/NAA ratio (p < 0.01), and between rCBF max and rADC min (p < 0.01). Significant differences between histologically classified low- and high-grade DMG, independently of H3K27M-mutation, were found among all imaging techniques (p ≤ 0.02). Significant differences in terms of rCBF max, rADC min, Cho/NAA and F-DOPA uptake were also found between molecularly classified mutant and wild-type DMG (p ≤ 0.02), even though wild-type DMG included low-grade astrocytomas, not present among mutant DMG. When comparing only histologically defined high-grade mutant and wild-type DMG, only the F-DOPA PET data T/S demonstrated statistically significant differences independently of histology (p < 0.003). ROC analysis demonstrated that T/S ratio was the best parameter for differentiating mutant from wild-type DMG (AUC 0.94, p < 0.001).
CONCLUSIONS
Advanced MRI and F-DOPA PET characteristics of DMG depend on histological features; however, F-DOPA PET-T/S was the only parameter able to discriminate H3K27M-mutant from wild-type DMG independently of histology.
目的
本研究旨在比较磁共振弥散加权成像（DWI）、质子磁共振波谱（H-MRS）和动脉自旋标记（ASL）灌注成像与 F-二羟苯丙氨酸（DOPA）PET 对儿科弥漫中线胶质瘤（DMG）H3K27M 突变型和野生型的诊断评估。
方法
我们回顾性分析了 22 例经组织学证实且分子学分类为 H3K27M 突变型（12 例）和野生型（10 例）的儿科 DMG 患者，这些患者在 F-DOPA PET 检查前 2 周内接受了 DWI、H-MRS 和 ASL 检查。DWI 衍生的相对最小表观弥散系数（rADC min）、H-MRS 数据[胆碱/N-乙酰天冬氨酸（Cho/NAA）、胆碱/肌酸（Cho/Cr）和乳酸的存在]和相对 ASL 衍生的最大脑血流（rCBF max）与 F-DOPA 摄取的肿瘤/正常组织（T/N）和肿瘤/纹状体（T/S）比值进行比较，并与 DMG 的组织学和分子特征相关联。统计学分析包括 Pearson's chi-square 和 Mann-Whitney U 检验、Spearman 秩相关和受试者工作特征（ROC）分析。
结果
不同技术之间相关性最高的是 T/S、rADC min 和 Cho/NAA 比值（p<0.01），以及 rCBF max 和 rADC min（p<0.01）。在组织学分类的低级别和高级别 DMG 中，独立于 H3K27M 突变，所有成像技术之间都存在显著差异（p≤0.02）。在分子学分类的突变型和野生型 DMG 中，rCBF max、rADC min、Cho/NAA 和 F-DOPA 摄取也存在显著差异（p≤0.02），尽管野生型 DMG 包括低级别星形细胞瘤，而突变型 DMG 中没有。当仅比较组织学定义的高级别突变型和野生型 DMG 时，只有 F-DOPA PET 的 T/S 独立于组织学显示出统计学显著差异（p<0.003）。ROC 分析表明，T/S 比值是区分突变型和野生型 DMG 的最佳参数（AUC 0.94，p<0.001）。
结论
DMG 的高级 MRI 和 F-DOPA PET 特征取决于组织学特征；然而，F-DOPA PET-T/S 是唯一能够独立于组织学区分 H3K27M 突变型和野生型 DMG 的参数。
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