青少年和成人中H3 K27M组蛋白突变型弥漫性中线胶质瘤的影像学特征
Imaging characteristics of H3 K27M histone-mutant diffuse midline glioma in teenagers and adults.
作者信息
Thust Stefanie, Micallef Caroline, Okuchi Sachi, Brandner Sebastian, Kumar Atul, Mankad Kshitij, Wastling Stephen, Mancini Laura, Jäger Hans Rolf, Shankar Ananth
机构信息
Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.
Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
出版信息
Quant Imaging Med Surg. 2021 Jan;11(1):43-56. doi: 10.21037/qims-19-954.
BACKGROUND
To assess anatomical and quantitative diffusion-weighted MR imaging features in a recently classified lethal neoplasm, H3 K27M histone-mutant diffuse midline glioma [World Health Organization (WHO) IV].
METHODS
Fifteen untreated gliomas in teenagers and adults (median age 19, range, 14-64) with confirmed H3 K27M histone-mutant genotype were analysed at a national referral centre. Morphological characteristics including tumour epicentre(s), T2/FLAIR and Gadolinium enhancement patterns, calcification, haemorrhage and cyst formation were recorded. Multiple apparent diffusion coefficient (ADC, ADC) regions of interest were sited in solid tumour and normal appearing white matter (ADC) using post-processing software (Olea Sphere v2.3, Olea Medical). ADC histogram data (2, 5, 10 percentile, median, mean, kurtosis, skewness) were calculated from volumetric tumour segmentations and tested against the regions of interest (ROI) data (Wilcoxon signed rank test).
RESULTS
The median interval from imaging to tissue diagnosis was 9 (range, 0-74) days. The structural MR imaging findings varied between individuals and within tumours, often featuring signal heterogeneity on all MR sequences. All gliomas demonstrated contact with the brain midline, and 67% exhibited rim-enhancing necrosis. The mean ROI ADC value was 0.84 (±0.15 standard deviation, SD) ×10 mm/s. In the largest tumour cross-section (excluding necrosis), an average ADC value of 1.12 (±0.25)×10 mm/s was observed. The mean ADC ratio was 1.097 (±0.149), and the mean ADC ratio measured 1.466 (±0.299). With the exception of the 2 centile, no statistical difference was observed between the regional and histogram derived ADC results.
CONCLUSIONS
H3 K27M-mutant gliomas demonstrate variable morphology and diffusivity, commonly featuring moderately low ADC values in solid tumour. Regional ADC measurements appeared representative of volumetric histogram data in this study.
背景
评估一种最近分类的致死性肿瘤——H3 K27M组蛋白突变型弥漫性中线胶质瘤（世界卫生组织（WHO）IV级）的解剖学和定量扩散加权磁共振成像特征。
方法
在一家国家转诊中心对15例未经治疗的青少年和成人胶质瘤（中位年龄19岁，范围14 - 64岁）进行分析，这些患者具有确诊的H3 K27M组蛋白突变基因型。记录包括肿瘤中心、T2/液体衰减反转恢复序列（FLAIR）和钆增强模式、钙化、出血和囊肿形成等形态学特征。使用后处理软件（Olea Sphere v2.3，Olea Medical）在实体瘤和外观正常的白质中设置多个感兴趣区（ROI）来测量表观扩散系数（ADC）。从肿瘤体积分割中计算ADC直方图数据（第2、5、10百分位数、中位数、均值、峰度、偏度），并与感兴趣区数据进行比较（Wilcoxon符号秩检验）。
结果
从成像到组织诊断的中位间隔时间为9天（范围0 - 74天）。结构磁共振成像结果在个体之间以及肿瘤内部存在差异，在所有磁共振序列上常表现为信号不均匀。所有胶质瘤均显示与脑中线接触，67%表现为边缘强化坏死。感兴趣区的平均ADC值为0.84（±0.15标准差，SD）×10⁻³mm²/s。在最大的肿瘤横截面（不包括坏死区域），观察到平均ADC值为1.12（±0.25）×10⁻³mm²/s。平均ADC比率为1.097（±0.149），测量的平均ADC比率为1.466（±0.299）。除第2百分位数外，区域ADC结果和直方图导出的ADC结果之间未观察到统计学差异。
结论
H3 K27M突变型胶质瘤表现出形态和扩散率的变异性，实体瘤中通常具有中度低ADC值。在本研究中，区域ADC测量似乎代表了体积直方图数据。
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