Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Korea.
Korean J Radiol. 2023 Feb;24(2):133-144. doi: 10.3348/kjr.2022.0732.
Cyclin-dependent kinase inhibitor (CDKN)2A/B homozygous deletion is a key molecular marker of isocitrate dehydrogenase (IDH)-mutant astrocytomas in the 2021 World Health Organization. We aimed to investigate whether qualitative and quantitative MRI parameters can predict CDKN2A/B homozygous deletion status in IDH-mutant astrocytomas.
Preoperative MRI data of 88 patients (mean age ± standard deviation, 42.0 ± 11.9 years; 40 females and 48 males) with IDH-mutant astrocytomas (76 without and 12 with CDKN2A/B homozygous deletion) from two institutions were included. A qualitative imaging assessment was performed. Mean apparent diffusion coefficient (ADC), 5th percentile of ADC, mean normalized cerebral blood volume (nCBV), and 95th percentile of nCBV were assessed via automatic tumor segmentation. Logistic regression was performed to determine the factors associated with CDKN2A/B homozygous deletion in all 88 patients and a subgroup of 47 patients with histological grades 3 and 4. The discrimination performance of the logistic regression models was evaluated using the area under the receiver operating characteristic curve (AUC).
In multivariable analysis of all patients, infiltrative pattern (odds ratio [OR] = 4.25, = 0.034), maximal diameter (OR = 1.07, = 0.013), and 95th percentile of nCBV (OR = 1.34, = 0.049) were independent predictors of CDKN2A/B homozygous deletion. The AUC, accuracy, sensitivity, and specificity of the corresponding model were 0.83 (95% confidence interval [CI], 0.72-0.91), 90.4%, 83.3%, and 75.0%, respectively. On multivariable analysis of the subgroup with histological grades 3 and 4, infiltrative pattern (OR = 10.39, = 0.012) and 95th percentile of nCBV (OR = 1.24, = 0.047) were independent predictors of CDKN2A/B homozygous deletion, with an AUC accuracy, sensitivity, and specificity of the corresponding model of 0.76 (95% CI, 0.60-0.88), 87.8%, 80.0%, and 58.1%, respectively.
The presence of an infiltrative pattern, larger maximal diameter, and higher 95th percentile of the nCBV may be useful MRI biomarkers for CDKN2A/B homozygous deletion in IDH-mutant astrocytomas.
细胞周期蛋白依赖性激酶抑制剂（CDKN）2A/B 纯合缺失是 2021 年世界卫生组织中异柠檬酸脱氢酶（IDH）突变星形细胞瘤的关键分子标志物。我们旨在研究定性和定量 MRI 参数是否可以预测 IDH 突变星形细胞瘤中 CDKN2A/B 纯合缺失状态。
本研究纳入了来自两个机构的 88 例 IDH 突变星形细胞瘤患者（平均年龄 ± 标准差，42.0 ± 11.9 岁；女性 40 例，男性 48 例）的术前 MRI 数据（76 例无 CDKN2A/B 纯合缺失，12 例有 CDKN2A/B 纯合缺失）。进行了定性影像学评估。通过自动肿瘤分割评估平均表观扩散系数（ADC）、ADC 的第 5 百分位数、平均归一化脑血容量（nCBV）和 nCBV 的第 95 百分位数。在所有 88 例患者和 47 例组织学分级为 3 级和 4 级的患者亚组中，进行了多变量逻辑回归分析，以确定与 CDKN2A/B 纯合缺失相关的因素。使用接收器工作特征曲线（ROC）下面积（AUC）评估逻辑回归模型的判别性能。
在所有患者的多变量分析中，浸润模式（优势比 [OR] = 4.25， = 0.034）、最大直径（OR = 1.07， = 0.013）和 nCBV 的第 95 百分位数（OR = 1.34， = 0.049）是 CDKN2A/B 纯合缺失的独立预测因子。相应模型的 AUC、准确性、敏感性和特异性分别为 0.83（95%置信区间 [CI]，0.72-0.91）、90.4%、83.3%和 75.0%。在组织学分级为 3 级和 4 级的亚组的多变量分析中，浸润模式（OR = 10.39， = 0.012）和 nCBV 的第 95 百分位数（OR = 1.24， = 0.047）是 CDKN2A/B 纯合缺失的独立预测因子，相应模型的 AUC、准确性、敏感性和特异性分别为 0.76（95%CI，0.60-0.88）、87.8%、80.0%和 58.1%。
存在浸润模式、较大的最大直径和较高的 nCBV 第 95 百分位数可能是 IDH 突变星形细胞瘤中 CDKN2A/B 纯合缺失的有用 MRI 生物标志物。
