Department of Radiology, The First Affiliated Hospital, Kunming Medical University, Kunming 650032, China.
Department of Oncologic Imaging, National Cancer Center, Singapore 169610.
Contrast Media Mol Imaging. 2020 Nov 22;2020:8843084. doi: 10.1155/2020/8843084. eCollection 2020.
Previous studies using contrast-enhanced imaging for glioma isocitrate dehydrogenase (IDH) mutation assessment showed promising yet inconsistent results, and this study attempts to explore this problem by using an advanced tracer kinetic model, the distributed parameter model (DP). Fifty-five patients with glioma examined using dynamic contrast-enhanced imaging sequence at a 3.0 T scanner were retrospectively reviewed. The imaging data were processed using DP, yielding the following parameters: blood flow , permeability-surface area product PS, fractional volume of interstitial space , fractional volume of intravascular space , and extraction ratio . The results were compared with the Tofts model. The Wilcoxon test and boxplot were utilized for assessment of differences of model parameters between IDH-mutant and IDH-wildtype gliomas. Spearman correlation was employed to investigate the relationship between DP and Tofts parameters. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis and quantified using the area under the ROC curve (AUC). Results showed that IDH-mutant gliomas were significantly lower in ( = 0.018), PS ( < 0.001), ( < 0.001), ( < 0.001), and ( = 0.002) than IDH-wildtype gliomas. In differentiating IDH-mutant and IDH-wildtype gliomas, had the best performance (AUC = 0.92), and the AUCs of PS and were 0.82 and 0.80, respectively. In comparison, Tofts parameters were lower in ( = 0.013) and ( < 0.001) for IDH-mutant gliomas. No significant difference was observed in ep ( = 0.525). The AUCs of , , and ep were 0.69, 0.79, and 0.55, respectively. Tofts-derived showed a strong correlation with DP-derived ( > 0.9, < 0.001). showed a weak correlation with ( < 0.3, > 0.16) and a very weak correlation with PS ( < 0.06, > 0.8), both of which were not statistically significant. The findings by DP revealed a tissue environment with lower vascularity, lower vessel permeability, and lower blood flow in IDH-mutant than in IDH-wildtype gliomas, being hostile to cellular differentiation of oncogenic effects in IDH-mutated gliomas, which might help to explain the better outcomes in IDH-mutated glioma patients than in glioma patients of IDH-wildtype. The advantage of DP over Tofts in glioma DCE data analysis was demonstrated in terms of clearer elucidation of tissue microenvironment and better performance in IDH mutation assessment.
先前使用对比增强成像评估胶质瘤异柠檬酸脱氢酶 (IDH) 突变的研究结果显示出有希望但不一致的结果，本研究试图通过使用先进的示踪剂动力学模型——分布参数模型 (DP) 来探索这个问题。回顾性分析了 55 例在 3.0T 扫描仪上使用动态对比增强成像序列检查的胶质瘤患者。使用 DP 处理成像数据，得到以下参数：血流 、通透性表面积乘积 PS、细胞外间隙分数 、血管内空间分数 、提取率 。将结果与 Tofts 模型进行比较。使用 Wilcoxon 检验和箱线图评估 IDH 突变型和 IDH 野生型胶质瘤之间模型参数的差异。采用 Spearman 相关分析探讨 DP 和 Tofts 参数之间的关系。使用接收器操作特征 (ROC) 曲线分析评估诊断性能，并使用 ROC 曲线下面积 (AUC) 进行量化。结果表明，IDH 突变型胶质瘤的 ( = 0.018)、PS ( < 0.001)、 ( < 0.001)、 ( < 0.001)和 ( = 0.002)均显著低于 IDH 野生型胶质瘤。在区分 IDH 突变型和 IDH 野生型胶质瘤时， 具有最佳性能 (AUC = 0.92)，PS 和 的 AUC 分别为 0.82 和 0.80。相比之下，IDH 突变型胶质瘤的 Tofts 参数在 ( = 0.013)和 ( < 0.001)中较低。ep 无显著差异 ( = 0.525)。 、 和 ep 的 AUC 分别为 0.69、0.79 和 0.55。Tofts 衍生的 与 DP 衍生的 呈强相关性 ( > 0.9， < 0.001)。 与 呈弱相关性 ( < 0.3， > 0.16)，与 PS 呈非常弱相关性 ( < 0.06， > 0.8)，均无统计学意义。DP 发现 IDH 突变型胶质瘤的血管生成、血管通透性和血流较低的组织环境，不利于 IDH 突变型胶质瘤中致癌效应的细胞分化，这可能有助于解释 IDH 突变型胶质瘤患者的预后优于 IDH 野生型胶质瘤患者的原因。DP 在胶质瘤 DCE 数据分析中的优势在于更清晰地阐明了组织微环境，并在 IDH 突变评估方面具有更好的性能。
