酰胺质子转移成像对低级别和高级别儿童脑胶质瘤的鉴别诊断：定量弛豫时间以外的附加价值。
Differentiation of low- and high-grade pediatric gliomas with amide proton transfer imaging: added value beyond quantitative relaxation times.
机构信息
Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Eur Radiol. 2021 Dec;31(12):9110-9119. doi: 10.1007/s00330-021-08039-w. Epub 2021 May 28.
OBJECTIVES
To evaluate whether amide proton transfer (APT) MRI can be used to characterize gliomas in pediatric patients and whether it provides added value beyond relaxation times.
METHODS
In this prospective study, APT imaging and relaxation time mapping were performed in 203 pediatric patients suspected of gliomas from February 2018 to December 2019. The region of interest (ROI) in the tumor was automatically generated with artifact detection and ROI-shrinking algorithms. Several APT-related metrics (CESTR, CESTR, MTR, AREX, and APT) and quantitative T1 and T2 were compared between low-grade and high-grade gliomas using the student's t-test or Mann-Whitney U-test. The performance of these parameters was assessed using the receiver operating characteristic (ROC) analysis. A stepwise multivariate logistic regression model was used to combine the imaging parameters.
RESULTS
Forty-eight patients (mean age: 6 ± 4 years; 23 males and 25 females) were included in the final analysis. All the APT-related metrics except APT had significantly (p < 0.05) higher values in the high-grade group than the low-grade group. Under different ROI-shrinking cutoffs, the quantitative T1 (p = 0.045-0.200) and T2 (p = 0.037-0.171) values of high-grade gliomas were typically lower than those of low-grade ones. The stepwise multivariate logistic regression revealed that CESTR and APT were combined significant predictors of glioma grades (p < 0.05), with an area under the ROC curve (AUC) of 0.86 substantially larger than those of T1 (AUC = 0.69) and T2 (AUC = 0.68).
CONCLUSIONS
APT imaging can be used to differentiate high-grade and low-grade gliomas in pediatric patients and provide added value beyond quantitative relaxation times.
KEY POINTS
• Amide proton transfer (APT) MRI showed significantly (p < 0.05) higher values in pediatric patients with high-grade gliomas than those with low-grade ones. • The area under the curve was 0.86 for APT MRI to differentiate low-grade and high-grade gliomas in pediatric patients, which was substantially higher than that for quantitative T1 (0.69) and T2 (0.68). • APT MRI demonstrated added value beyond quantitative T1 and T2 mapping in characterizing pediatric gliomas.
目的
评估酰胺质子转移（APT）MRI 是否可用于对儿科患者脑胶质瘤进行特征描述，以及它是否能提供比弛豫时间更有价值的信息。
方法
在这项前瞻性研究中，我们对 2018 年 2 月至 2019 年 12 月期间怀疑患有脑胶质瘤的 203 名儿科患者进行了 APT 成像和弛豫时间图分析。利用伪影检测和 ROI 缩小算法，在肿瘤的感兴趣区域（ROI）自动生成。使用学生 t 检验或曼-惠特尼 U 检验，比较低级别和高级别胶质瘤之间的几种 APT 相关指标（CESTR、CESTR、MTR、AREX 和 APT）和定量 T1 和 T2。使用受试者工作特征（ROC）分析评估这些参数的性能。采用逐步多元逻辑回归模型对影像学参数进行组合。
结果
最终有 48 名患者（平均年龄：6±4 岁；男 23 例，女 25 例）纳入了最终分析。在高级别组中，所有 APT 相关指标（除 APT 外）均显著高于低级别组（p＜0.05）。在不同的 ROI 缩小截止值下，高级别胶质瘤的定量 T1（p=0.045-0.200）和 T2（p=0.037-0.171）值通常低于低级别胶质瘤。逐步多元逻辑回归显示，CESTR 和 APT 联合是胶质瘤分级的显著预测因子（p＜0.05），ROC 曲线下面积（AUC）为 0.86，明显大于 T1（AUC=0.69）和 T2（AUC=0.68）。
结论
APT 成像可用于区分儿科患者的高级别和低级别脑胶质瘤，并提供比定量弛豫时间更有价值的信息。
关键点
APT MRI 显示儿科患者高级别脑胶质瘤的CESTR 值明显高于低级别脑胶质瘤（p＜0.05）。
APT MRI 用于区分儿科患者低级别和高级别脑胶质瘤的 AUC 为 0.86，明显高于定量 T1（0.69）和 T2（0.68）。
APT MRI 在对儿科脑胶质瘤进行特征描述方面，提供了比定量 T1 和 T2 映射更有价值的信息。
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