成人低级别胶质瘤患者 T2-FLAIR 不匹配征象与 IDH 突变状态的放射基因组关联：一项更新的系统评价和荟萃分析。
Radiogenomic association between the T2-FLAIR mismatch sign and IDH mutation status in adult patients with lower-grade gliomas: an updated systematic review and meta-analysis.
机构信息
Department of Radiology, the First Affiliated Hospital, Jinan University, No.613, Huangpu West Road, Tianhe District, Guangzhou, Guangdong, People's Republic of China.
Graduate College, Jinan University, Guangzhou, Guangdong, People's Republic of China.
出版信息
Eur Radiol. 2022 Aug;32(8):5339-5352. doi: 10.1007/s00330-022-08607-8. Epub 2022 Feb 15.
OBJECTIVES
To reveal a radiogenomic correlation between the presence of the T2-fluid-attenuated inversion recovery resection (T2-FLAIR) mismatch sign on MR images and isocitrate dehydrogenase (IDH) mutation status in adult patients with lower-grade gliomas (LGGs).
METHODS
A web-based systemic search for eligible literature up to April 13, 2021, was conducted on PubMed, Embase, and the Cochrane Library databases by two independent reviewers. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We included studies evaluating the accuracy of the T2-FLAIR mismatch sign in diagnosing the IDH mutation in adult patients with LGGs. The T2-FLAIR mismatch sign was defined as a T2-hyperintense lesion that is hypointense on FLAIR except for a hyperintense rim.
RESULTS
Fourteen studies (n = 1986) were finally identified. The mean age of patients in the included studies ranged from 38.5 to 56 years. The pooled area under the curve (AUC), sensitivity, and specificity were obtained for each molecular profile: IDHmut-Codel: 0.46 (95% confidence interval [CI]: 0.42-0.50), 1% (95%CI: 0-7%), and 69% (95%CI: 62-75%), respectively; IDHmut-Noncodel: 0.75 (95%CI: 0.71-0.79), 42% (95%CI: 34-50%), and 99% (95%CI: 96-100%), respectively; IDH-Mutation regardless of 1p/19q codeletion status: 0.77 (95%CI: 0.73-0.80), 29% (95%CI: 21-40%), and 99% (95%CI: 92-100%), respectively.
CONCLUSIONS
The T2-FLAIR mismatch sign was an insensitive but highly specific marker for IDHmut-Noncodel and IDH-Mutation LGGs, whereas it was not a useful marker for IDHmut-Codel LGGs. The findings might identify the T2-FLAIR mismatch sign as a non-invasive imaging biomarker for the selection of patients with IDH-mutant LGGs.
KEY POINTS
• The T2-FLAIR mismatch sign was not a sensitive sign for IDH mutation in LGGs. • The T2-FLAIR mismatch sign was related to IDHmut-Noncodel with a specificity of 99%. • The pooled specificity (69%) of the T2-FLAIR mismatch sign for IDHmut-Codel was low.
目的
揭示磁共振成像上 T2 液体衰减反转恢复切除（T2-FLAIR）不匹配征象与成人低级别胶质瘤（LGG）患者异柠檬酸脱氢酶（IDH）突变状态之间的放射基因组相关性。
方法
两位独立的审查员于 2021 年 4 月 13 日之前，在 PubMed、Embase 和 Cochrane 图书馆数据库中进行了基于网络的系统文献搜索，以寻找符合条件的文献。本研究按照系统评价和荟萃分析的首选报告项目进行。我们纳入了评估 T2-FLAIR 不匹配征象在诊断成人 LGG 患者 IDH 突变中的准确性的研究。T2-FLAIR 不匹配征象定义为 T2 高信号病变，在 FLAIR 上呈低信号，除了高信号边缘。
结果
最终确定了 14 项研究（n = 1986）。纳入研究中患者的平均年龄为 38.5 至 56 岁。分别获得了每个分子谱的曲线下面积（AUC）、敏感性和特异性：IDHmut-Codel：0.46（95%置信区间[CI]：0.42-0.50）、1%（95%CI：0-7%）和 69%（95%CI：62-75%）；IDHmut-Noncodel：0.75（95%CI：0.71-0.79）、42%（95%CI：34-50%）和 99%（95%CI：96-100%）；无论 1p/19q 编码缺失状态如何的 IDH 突变：0.77（95%CI：0.73-0.80）、29%（95%CI：21-40%）和 99%（95%CI：92-100%）。
结论
T2-FLAIR 不匹配征象是 IDHmut-Noncodel 和 IDH-Mutation LGG 的一种不敏感但高度特异的标志物，而对于 IDHmut-Codel LGG 则不是有用的标志物。这些发现可能将 T2-FLAIR 不匹配征象确定为 IDH 突变型 LGG 患者选择的一种非侵入性影像学生物标志物。
重点
• T2-FLAIR 不匹配征象不是 LGG 中 IDH 突变的敏感征象。• T2-FLAIR 不匹配征象与 IDHmut-Noncodel 相关，特异性为 99%。• T2-FLAIR 不匹配征象对 IDHmut-Codel 的总体特异性（69%）较低。
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