Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangdong, 510080, Guangzhou, People's Republic of China.
Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou, Guangdong, People's Republic of China.
Eur Radiol. 2023 Oct;33(10):6636-6647. doi: 10.1007/s00330-023-09647-4. Epub 2023 Apr 25.
OBJECTIVES: To comprehensively evaluate the glioma using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS: Forty-two patients (18 women; mean age, 45 years) with pathologically confirmed gliomas were retrospectively included. All the patients underwent conventional and advanced MRI examinations (QSM, DWI, MRS, etc.). Five patients underwent paired QSM (pre- and post-enhancement). Four Visually Accessible Rembrandt Image (VASARI) features and intratumoural susceptibility signal (ITSS) were observed. Three ROIs each were manually drawn separately in the tumour parenchyma with relatively high and low magnetic susceptibility. The association between the tumour's magnetic susceptibility and other MRI parameters was also analysed. RESULTS: Morphologically, gliomas with heterogeneous ITSS were more similar to high-grade gliomas (p = 0.006, AUC: 0.72, sensitivity: 70%, and specificity: 73%). Heterogeneous ITSS was significantly associated with tumour haemorrhage, necrosis, diffusion restriction, and avid enhancement but did not change between pre- and post-enhanced QSM. Quantitatively, tumour parenchyma magnetic susceptibility had limited value in grading gliomas and identifying IDH mutation status, whereas the relatively low magnetic susceptibility of the tumour parenchyma helped identify oligodendrogliomas in IDH mutated gliomas (AUC = 0.78) with high specificity (100%). The relatively high tumour magnetic susceptibility significantly increased after enhancement (p = 0.039). Additionally, we found that the magnetic susceptibility of the tumour parenchyma was significantly correlated with ADC (r = 0.61) and Cho/NAA (r = 0.40). CONCLUSIONS: QSM is a promising candidate for the comprehensive evaluation of gliomas, except for IDH mutation status. The magnetic susceptibility of tumour parenchyma may be affected by tumour cell proliferation. KEY POINTS: • Morphologically, gliomas with a heterogeneous intratumoural susceptibility signal (ITSS) are more similar to high-grade gliomas (p = 0.006; AUC, 0.72; sensitivity, 70%; and specificity, 73%). Heterogeneous ITSS was significantly associated with tumour haemorrhage, necrosis, diffusion restriction, and avid enhancement but did not change between pre- and post-enhanced QSM. • Tumour parenchyma's relatively low magnetic susceptibility helped identify oligodendroglioma with high specificity. • Tumour parenchyma magnetic susceptibility was significantly correlated with ADC (r = 0.61) and Cho/NAA (r = 0.40).
目的：全面评估脑胶质瘤的情况，使用定量磁化率映射（QSM）技术。
材料与方法：回顾性纳入 42 例经病理证实的脑胶质瘤患者（18 名女性；平均年龄 45 岁）。所有患者均接受了常规和高级 MRI 检查（QSM、DWI、MRS 等）。5 例患者进行了配对 QSM（增强前后）检查。观察了 4 种 Visually Accessible Rembrandt Image（VASARI）特征和肿瘤内磁化率信号（ITSS）。在肿瘤实质内相对高和低磁化率的部位分别手动绘制了 3 个 ROI。还分析了肿瘤的磁化率与其他 MRI 参数之间的相关性。
结果：形态学上，具有不均匀 ITSS 的脑胶质瘤更类似于高级别胶质瘤（p=0.006，AUC：0.72，敏感性：70%，特异性：73%）。不均匀 ITSS 与肿瘤出血、坏死、弥散受限和强化明显相关，但在增强前后的 QSM 中没有变化。定量方面，肿瘤实质的磁化率在胶质瘤分级和 IDH 突变状态的鉴别中价值有限，而肿瘤实质的相对低磁化率有助于在 IDH 突变的脑胶质瘤中识别少突胶质细胞瘤（AUC=0.78，特异性为 100%）。增强后肿瘤实质的相对高磁化率显著增加（p=0.039）。此外，我们发现肿瘤实质的磁化率与 ADC（r=0.61）和 Cho/NAA（r=0.40）显著相关。
结论：除了 IDH 突变状态外，QSM 是一种很有前途的脑胶质瘤综合评估方法。肿瘤实质的磁化率可能受肿瘤细胞增殖的影响。
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