Department of Cancer Imaging, Peter MacCallum Cancer Centre, Grattan St, Melbourne, Victoria, 3000, Australia.
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.
Neuroradiology. 2021 Mar;63(3):353-362. doi: 10.1007/s00234-020-02532-7. Epub 2020 Aug 25.
Molecular parameters have become integral to glioma diagnosis. Much of radiogenomics research has focused on the use of advanced MRI techniques, but conventional MRI sequences remain the mainstay of clinical assessments. The aim of this research was to synthesize the current published data on the accuracy of standard clinical MRI for diffuse glioma genotyping, specifically targeting IDH and 1p19q status.
A systematic search was performed in September 2019 using PubMed and the Cochrane Library, identifying studies on the diagnostic value of T1 pre-/post-contrast, T2, FLAIR, T2*/SWI and/or 3-directional diffusion-weighted imaging sequences for the prediction of IDH and/or 1p19q status in WHO grade II-IV diffuse astrocytic and oligodendroglial tumours as defined in the WHO 2016 Classification of CNS Tumours.
Forty-four studies including a total of 5286 patients fulfilled the inclusion criteria. Correlations between key glioma molecular markers, namely IDH and 1p19q, and distinctive MRI findings have been established, including tumour location, signal composition (including the T2-FLAIR mismatch sign) and apparent diffusion coefficient values.
Consistent trends have emerged indicating that conventional MRI is valuable for glioma genotyping, particularly in presumed lower grade glioma. However, due to limited interobserver testing, the reproducibility of qualitatively assessed visual features remains an area of uncertainty.
分子参数已成为神经胶质瘤诊断的重要组成部分。许多放射基因组学研究都集中在使用先进的 MRI 技术，但常规 MRI 序列仍然是临床评估的主要方法。本研究旨在综合目前关于弥散性神经胶质瘤基因分型中标准临床 MRI 准确性的已发表数据，特别是针对 IDH 和 1p19q 状态。
2019 年 9 月，我们通过 PubMed 和 Cochrane 图书馆进行了系统搜索，确定了关于 T1 增强前后、T2、FLAIR、T2* / SWI 和/或 3 个方向弥散加权成像序列对 IDH 和/或 1p19q 状态预测的诊断价值的研究，这些序列用于预测世界卫生组织 2016 年中枢神经系统肿瘤分类中定义的 II-IV 级弥漫性星形细胞瘤和少突胶质细胞瘤的 IDH 和/或 1p19q 状态。
44 项研究共纳入 5286 例患者，符合纳入标准。已经确定了关键的神经胶质瘤分子标志物（即 IDH 和 1p19q）与独特的 MRI 发现之间的相关性，包括肿瘤位置、信号组成（包括 T2-FLAIR 不匹配征）和表观扩散系数值。
一致的趋势表明，常规 MRI 对神经胶质瘤基因分型有价值，特别是在假定的低级别神经胶质瘤中。然而，由于观察者间测试有限，定性评估的视觉特征的可重复性仍然是一个不确定的领域。
