Department of Neurosurgical Oncology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing Neurosurgical Institute, Beijing, 100070, China.
Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Eur Radiol. 2023 Jun;33(6):4440-4452. doi: 10.1007/s00330-022-09314-0. Epub 2022 Dec 15.
The purpose of this study was to investigate the clinical utility of the sinuous, wave-like intratumoral-wall (SWITW) sign on T2WI in diagnosing isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (IDHmut-Codel) oligodendrogliomas, for which a relatively conservative resection strategy might be sufficient due to a better response to chemoradiotherapy and favorable prognosis.
Imaging data from consecutive adult patients with diffuse lower-grade gliomas (LGGs, histological grades 2-3) in Beijing Tiantan Hospital (December 1, 2013, to October 31, 2021, BTH set, n = 711) and the Cancer Imaging Archive (TCIA) LGGs set (n = 117) were used to develop and validate our findings. Two independent observers assessed the SWITW sign and some well-reported discriminative radiological features to establish a practical diagnostic strategy.
The SWITW sign showed satisfying sensitivity (0.684 and 0.722 for BTH and TCIA sets) and specificity (0.938 and 0.914 for BTH and TCIA sets) in defining IDHmut-Codels, and the interobserver agreement was substantial (κ 0.718 and 0.756 for BTH and TCIA sets). Compared to calcification, the SWITW sign improved the sensitivity by 0.28 (0.404 to 0.684) in the BTH set, and 81.0% (277/342) of IDHmut-Codel cases demonstrated SWITW and/ or calcification positivity. Combining the SWITW sign, calcification, low ADC values, and other discriminative features, we established a concise and reliable diagnostic protocol for IDHmut-Codels.
The SWITW sign was a sensitive and specific imaging biomarker for IDHmut-Codels. The integrated protocol provided an explicable, efficient, and reproducible method for precise preoperative diagnosis, which was essential to guide individualized surgical plan-making.
• The SWITW sign was a sensitive and specific imaging biomarker for IDHmut-Codel oligodendrogliomas. • The SWITW sign was more sensitive than calcification and an integrated strategy could improve diagnostic sensitivity for IDHmut-Codel oligodendrogliomas. • Combining SWITW, calcification, low ADC values, and other discriminative features could make a precise preoperative diagnosis for IDHmut-Codel oligodendrogliomas.
本研究旨在探讨 T2WI 上肿瘤内迂曲波浪状壁（SWITW）征对异柠檬酸脱氢酶（IDH）突变和 1p/19q 共缺失（IDHmut-Codel）少突胶质细胞瘤的临床应用价值，对于这些肿瘤，由于对放化疗反应良好且预后较好，因此相对保守的切除策略可能就足够了。
本研究使用了来自北京天坛医院（2013 年 12 月 1 日至 2021 年 10 月 31 日，BTH 组，n = 711）和癌症影像档案（TCIA）低级别胶质瘤（LGG）组（n = 117）的连续成人弥漫性低级别胶质瘤（LGG，组织学 2-3 级）患者的影像学数据来开发和验证我们的研究结果。两位独立的观察者评估了 SWITW 征和一些公认的有鉴别意义的影像学特征，以建立一种实用的诊断策略。
SWITW 征在定义 IDHmut-Codel 方面具有令人满意的敏感性（BTH 和 TCIA 组分别为 0.684 和 0.722）和特异性（BTH 和 TCIA 组分别为 0.938 和 0.914），观察者间的一致性较高（BTH 和 TCIA 组的κ 值分别为 0.718 和 0.756）。与钙化相比，SWITW 征在 BTH 组中提高了 0.28 的敏感性（从 0.404 提高到 0.684），并且 81.0%（277/342）的 IDHmut-Codel 病例表现出 SWITW 和/或钙化阳性。结合 SWITW 征、钙化、低 ADC 值和其他有鉴别意义的特征，我们建立了一个简明可靠的 IDHmut-Codel 诊断方案。
SWITW 征是 IDHmut-Codel 少突胶质细胞瘤的一种敏感且特异的影像学生物标志物。综合方案为精确的术前诊断提供了一种可解释、高效和可重复的方法，这对于指导个体化手术方案的制定至关重要。
SWITW 征是 IDHmut-Codel 少突胶质细胞瘤的一种敏感且特异的影像学生物标志物。
SWITW 征比钙化更敏感，综合策略可以提高 IDHmut-Codel 少突胶质细胞瘤的诊断敏感性。
结合 SWITW、钙化、低 ADC 值和其他有鉴别意义的特征，可以对 IDHmut-Codel 少突胶质细胞瘤进行精确的术前诊断。
