Gazi University, School of Medicine, Department of Radiology, Ankara, Turkey.
Gazi University, School of Medicine, Department of Radiology, Ankara, Turkey.
Acad Radiol. 2022 Mar;29 Suppl 3:S52-S62. doi: 10.1016/j.acra.2021.02.002. Epub 2021 Mar 6.
RATIONALE AND OBJECTIVES: We aimed to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic susceptibility contrast-enhanced (DSC) magnetic resonance imaging (MRI) parameters in the noninvasive prediction of the isocitrate dehydrogenase (IDH) mutation status in high-grade gliomas (HGGs). MATERIALS AND METHODS: A total of 58 patients with histopathologically proved HGGs were included in this retrospective study. All patients underwent multiparametric MRI on 3-T, including DSC-MRI and DWI before surgery. The mean apparent diffusion coefficient (ADC), relative maximum cerebral blood volume (rCBV), and percentage signal recovery (PSR) of the tumor core were measured and compared depending on the IDH mutation status and tumor grade. The Mann-Whitney U test was used to detect statistically significant differences in parameters between IDH-mutant-type (IDH-m-type) and IDH-wild-type (IDH-w-type) HGGs. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the diagnostic performance. RESULTS: The rCBV was significantly higher, and the PSR value was significantly lower in IDH-w-type tumors than in the IDH-m group (p = 0.002 and <0.001, respectively).The ADC value in IDH-w-type tumors was significantly lower compared with the one in IDH-m types (p = 0.023), but remarkable overlaps were found between the groups. The PSR showed the best diagnostic performance with an AUC of 0.938 and with an accuracy rate of 0.87 at the optimal cutoff value of 86.85. The combination of the PSR and the rCBV for the identification of the IDH mutation status increased the discrimination ability at the AUC level of 0.955. In terms of each tumor grade, the PSR and rCBV showed significant differences between the IDH-m and IDH-w groups (p ≤0.001). CONCLUSION: The rCBV and PSR from DSC-MRI may be feasible noninvasive imaging parameters for predicting the IDH mutation status in HGGs. The standardization of the imaging protocol is indispensable to the utility of DSC perfusion MRI in wider clinical usage.
背景与目的：本研究旨在评估扩散加权成像（DWI）和动态对比增强磁共振成像（DSC-MRI）参数在高级别胶质瘤（HGG）患者无创预测异柠檬酸脱氢酶（IDH）突变状态中的诊断性能。
材料与方法：回顾性分析 58 例经组织病理学证实的 HGG 患者的临床资料，所有患者均于术前在 3.0T 磁共振仪上行 DSC-MRI 和 DWI 检查。测量肿瘤实质核心的平均表观扩散系数（ADC）、相对最大脑血容量（rCBV）和信号恢复百分比（PSR），并根据 IDH 突变状态和肿瘤分级进行比较。采用 Mann-Whitney U 检验比较 IDH 突变型（IDH-m 型）和 IDH 野生型（IDH-w 型）HGG 之间参数的统计学差异。采用受试者工作特征曲线（ROC）分析评价诊断效能。
结果：与 IDH-m 型肿瘤相比，IDH-w 型肿瘤的 rCBV 明显升高，PSR 值明显降低（p=0.002 和 <0.001）。与 IDH-m 型肿瘤相比，IDH-w 型肿瘤的 ADC 值明显降低（p=0.023），但两组之间存在显著重叠。PSR 的 AUC 为 0.938，最佳截断值为 86.85%时，诊断准确率为 87%，具有最佳的诊断效能。PSR 与 rCBV 联合鉴别 IDH 突变状态可提高 AUC 水平的鉴别能力（0.955）。在每个肿瘤分级中，IDH-m 型和 IDH-w 型肿瘤之间的 PSR 和 rCBV 均有显著差异（p≤0.001）。
结论：DSC-MRI 的 rCBV 和 PSR 可能是预测 HGG 中 IDH 突变状态的无创性影像学参数。为了在更广泛的临床应用中推广 DSC 灌注 MRI，需要对成像方案进行标准化。
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