Xie Zhiyan, Li Jixian, Zhang Yue, Zhou Ruizhi, Zhang Hua, Duan Chongfeng, Liu Song, Niu Lei, Zhao Jiping, Liu Yingchao, Song Shuangshuang, Liu Xuejun
Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Front Neurosci. 2023 Jan 11;16:1099019. doi: 10.3389/fnins.2022.1099019. eCollection 2022.
To non-invasively predict the coexistence of isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in adult-type diffuse gliomas using apparent diffusion coefficient (ADC) histogram and direct ADC measurements and compare the diagnostic performances of the two methods.
A total of 118 patients with adult-type diffuse glioma who underwent preoperative brain magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) were included in this retrospective study. The patient group included 40 patients with coexisting IDH mutation and MGMT promoter methylation (IDHmut/MGMTmet) and 78 patients with other molecular status, including 32 patients with IDH wildtype and MGMT promoter methylation (IDHwt/MGMTmet), one patient with IDH mutation and unmethylated MGMT promoter (IDHmut/MGMTunmet), and 45 patients with IDH wildtype and unmethylated MGMT promoter (IDHwt/MGMTunmet). ADC histogram parameters of gliomas were extracted by delineating the region of interest (ROI) in solid components of tumors. The minimum and mean ADC of direct ADC measurements were calculated by placing three rounded or elliptic ROIs in solid components of gliomas. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the diagnostic performances of the two methods.
The 10th percentile, median, mean, root mean squared, 90th percentile, skewness, kurtosis, and minimum of ADC histogram analysis and minimum and mean ADC of direct measurements were significantly different between IDHmut/MGMTmet and the other glioma group ( < 0.001 to = 0.003). In terms of single factors, 10th percentile of ADC histogram analysis had the best diagnostic efficiency (AUC = 0.860), followed by mean ADC obtained by direct measurements (AUC = 0.844). The logistic regression model combining ADC histogram parameters and direct measurements had the best diagnostic efficiency (AUC = 0.938), followed by the logistic regression model combining the ADC histogram parameters with statistically significant difference (AUC = 0.916) and the logistic regression model combining minimum ADC and mean ADC (AUC = 0.851).
Both ADC histogram analysis and direct measurements have potential value in predicting the coexistence of IDHmut and MGMTmet in adult-type diffuse glioma. The diagnostic performance of ADC histogram analysis was better than that of direct ADC measurements. The combination of the two methods showed the best diagnostic performance.
使用表观扩散系数（ADC）直方图和直接ADC测量值对成人型弥漫性胶质瘤中异柠檬酸脱氢酶（IDH）突变与O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化的共存情况进行无创预测，并比较这两种方法的诊断性能。
本回顾性研究纳入了118例接受术前脑磁共振成像（MRI）和扩散加权成像（DWI）的成人型弥漫性胶质瘤患者。患者组包括40例IDH突变与MGMT启动子甲基化共存的患者（IDHmut/MGMTmet）和78例其他分子状态的患者，其中包括32例IDH野生型与MGMT启动子甲基化的患者（IDHwt/MGMTmet）、1例IDH突变与MGMT启动子未甲基化的患者（IDHmut/MGMTunmet）以及45例IDH野生型与MGMT启动子未甲基化的患者（IDHwt/MGMTunmet）。通过在肿瘤实性成分中勾勒感兴趣区（ROI）来提取胶质瘤的ADC直方图参数。通过在胶质瘤实性成分中放置三个圆形或椭圆形ROI来计算直接ADC测量的最小ADC值和平均ADC值。采用受试者操作特征（ROC）曲线分析和曲线下面积（AUC）来评估这两种方法的诊断性能。
IDHmut/MGMTmet组与其他胶质瘤组之间，ADC直方图分析的第10百分位数、中位数、平均值、均方根、第90百分位数、偏度、峰度和最小值以及直接测量的最小ADC值和平均ADC值均存在显著差异（<0.001至=0.003）。单因素方面，ADC直方图分析的第10百分位数诊断效率最佳（AUC=0.860），其次是直接测量获得的平均ADC值（AUC=0.844）。结合ADC直方图参数和直接测量的逻辑回归模型诊断效率最佳（AUC=0.938），其次是结合具有统计学显著差异的ADC直方图参数的逻辑回归模型（AUC=0.916）以及结合最小ADC值和平均ADC值的逻辑回归模型（AUC=0.851）。
ADC直方图分析和直接测量在预测成人型弥漫性胶质瘤中IDHmut与MGMTmet的共存情况方面均具有潜在价值。ADC直方图分析的诊断性能优于直接ADC测量。两种方法联合使用显示出最佳的诊断性能。
