[表观扩散系数直方图分析：弥漫性低级别胶质瘤基因亚型的鉴别]
[Apparent Diffusion Coefficient Histogram Analysis:Differentiation of Genetic Subtypes of Diffuse Lower-grade Gliomas].
作者信息
Liu Dan, Xu Jing-Mei, Liao Hong-Fan, Wen Ming
出版信息
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Aug 30;42(4):444-451. doi: 10.3881/j.issn.1000-503X.11608.
To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH group),19 patients with IDH-mutant 1p19q intact gliomas(IDH 1p19q group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH 1p19q group).The whole-lesion ADC values derived from histogram analysis(including ADC,ADC,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADC,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's test or Mann-Whitney test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Compared with IDH group,the ADC75%(=0.021),ADC90%(=0.015),ADC95%(=0.014),ADC (=0.035),range(=0.009),standard deviation(=0.001)and inhomogeneity(=0.001)were significantly lower in IDH group;in contrast,the ADC (=0.031)and kurtosis(=0.020)of IDH group were significantly higher than those in IDH group.The ADC(=0.010),ADC5%(=0.016),ADC10%(=0.012),ADC25%(=0.007),ADC50%(=0.005),ADC75%(=0.015),and mode(=0.002)were significantly higher in IDH 1p19q group than in IDH 1p19q group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH gliomas and IDH gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH 1p19q gliomas and IDH 1p19q gliomas,with a cutoff value was 1448.75×10 mm /s;the sensitivity and specificity were 57.9% and 90.9%. ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.
探讨表观扩散系数（ADC）直方图分析在鉴别弥漫性低级别胶质瘤基因亚型中的应用价值。回顾性分析了在本中心接受术前常规脑磁共振成像及扩散加权成像的55例世界卫生组织（WHO）Ⅱ/Ⅲ级弥漫性低级别胶质瘤患者。其中，14例为异柠檬酸脱氢酶（IDH）野生型胶质瘤（IDH野生型组），19例为IDH突变型且1p19q完整的胶质瘤（IDH 1p19q完整组），22例为IDH突变型且1p19q共缺失的胶质瘤（IDH 1p19q共缺失组）。对每位患者通过直方图分析得出全瘤ADC值（包括ADC、ADC、ADC5%、ADC10%、ADC25%、ADC50%、ADC75%、ADC90%、ADC95%、ADC、众数、范围、偏度、峰度、标准差、不均匀性和熵）。采用Student's检验或Mann-Whitney检验比较不同基因亚型之间的所有参数。采用受试者操作特征曲线（ROC）分析评估ADC直方图在区分不同基因亚型中的诊断性能。与IDH野生型组相比，IDH 1p19q共缺失组的ADC75%（=0.021）、ADC90%（=0.015）、ADC95%（=0.014）、ADC（=0.035）、范围（=0.009）、标准差（=0.001）和不均匀性（=0.001）显著更低；相反，IDH 1p19q完整组的ADC（=0.031）和峰度（=0.020）显著高于IDH 1p19q共缺失组。IDH 1p19q完整组的ADC（=0.010）、ADC5%（=0.016）、ADC10%（=0.012）、ADC25%（=0.007）、ADC50%（=0.005）、ADC75%（=0.015）和众数（=0.002）显著高于IDH 1p19q共缺失组。在鉴别IDH野生型胶质瘤和IDH 1p19q共缺失型胶质瘤时，不均匀性的ROC曲线下面积（AUC）最高（0.811），截断值为0.229；敏感性和特异性分别为85.7%和73.2%。在鉴别IDH 1p19q完整型胶质瘤和IDH 1p19q共缺失型胶质瘤时，众数的AUC最高（0.744），截断值为1448.75×10⁻⁶mm²/s；敏感性和特异性分别为57.9%和90.9%。ADC直方图分析可能有助于鉴别低级别胶质瘤的基因亚型。
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