Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China.
Department of Pathology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, 350005, People's Republic of China.
Eur Radiol. 2023 Oct;33(10):7003-7014. doi: 10.1007/s00330-023-09695-w. Epub 2023 May 3.
Noninvasive detection of molecular status of astrocytoma is of great clinical significance for predicting therapeutic response and prognosis. We aimed to evaluate whether morphological MRI (mMRI), SWI, DWI, and DSC-PWI could predict Ki-67 labeling index (LI), ATRX mutation, and MGMT promoter methylation status in IDH mutant (IDH-mut) astrocytoma.
We retrospectively analyzed mMRI, SWI, DWI, and DSC-PWI in 136 patients with IDH-mut astrocytoma.The features of mMRI and intratumoral susceptibility signals (ITSS) were compared using Fisher exact test or chi-square tests. Wilcoxon rank sum test was used to compare the minimum ADC (ADC), and minimum relative ADC (rADC) of IDH-mut astrocytoma in different molecular markers status. Mann-Whitney U test was used to compare the rCBV of IDH-mut astrocytoma with different molecular markers status. Receiver operating characteristic curves was performed to evaluate their diagnostic performances.
ITSS, ADC, rADC, and rCBV were significantly different between high and low Ki-67 LI groups. ITSS, ADC, and rADC were significantly different between ATRX mutant and wild-type groups. Necrosis, edema, enhancement, and margin pattern were significantly different between low and high Ki-67 LI groups. Peritumoral edema was significantly different between ATRX mutant and wild-type groups. Grade 3 IDH-mut astrocytoma with unmethylated MGMT promoter was more likely to show enhancement compared to the methylated group.
mMRI, SWI, DWI, and DSC-PWI were shown to have the potential to predict Ki-67 LI and ATRX mutation status in IDH-mut astrocytoma. A combination of mMRI and SWI may improve diagnostic performance for predicting Ki-67 LI and ATRX mutation status.
Conventional MRI and functional MRI (SWI, DWI, and DSC-PWI) can predict Ki-67 expression and ATRX mutation status of IDH mutant astrocytoma, which may help clinicians determine personalized treatment plans and predict patient outcomes.
• A combination of multimodal MRI may improve the diagnostic performance to predict Ki-67 LI and ATRX mutation status. • Compared with IDH-mutant astrocytoma with low Ki-67 LI, IDH-mutant astrocytoma with high Ki-67 LI was more likely to show necrosis, edema, enhancement, poorly defined margin, higher ITSS levels, lower ADC, and higher rCBV. • ATRX wild-type IDH-mutant astrocytoma was more likely to show edema, higher ITSS levels, and lower ADC compared to ATRX mutant IDH-mutant astrocytoma.
非侵入性检测星形细胞瘤的分子状态对预测治疗反应和预后具有重要的临床意义。我们旨在评估形态磁共振成像（mMRI）、SWI、DWI 和 DSC-PWI 是否可以预测 IDH 突变（IDH-mut）星形细胞瘤中的 Ki-67 标记指数（LI）、ATRX 突变和 MGMT 启动子甲基化状态。
我们回顾性分析了 136 例 IDH-mut 星形细胞瘤患者的 mMRI、SWI、DWI 和 DSC-PWI。使用 Fisher 精确检验或卡方检验比较 mMRI 和肿瘤内磁化率信号（ITSS）的特征。使用 Wilcoxon 秩和检验比较不同分子标志物状态下 IDH-mut 星形细胞瘤的最小 ADC（ADC）和最小相对 ADC（rADC）。使用 Mann-Whitney U 检验比较不同分子标志物状态下 IDH-mut 星形细胞瘤的 rCBV。通过受试者工作特征曲线评估它们的诊断性能。
Ki-67 LI 高、低组间 ITSS、ADC、rADC 和 rCBV 差异有统计学意义。ATRX 突变和野生型组间 ITSS、ADC 和 rADC 差异有统计学意义。Ki-67 LI 高、低组间坏死、水肿、增强和边缘模式差异有统计学意义。ATRX 野生型和突变型组间瘤周水肿差异有统计学意义。未甲基化 MGMT 启动子的 3 级 IDH-mut 星形细胞瘤增强的可能性高于甲基化组。
mMRI、SWI、DWI 和 DSC-PWI 显示出在 IDH-mut 星形细胞瘤中预测 Ki-67 LI 和 ATRX 突变状态的潜力。mMRI 和 SWI 的组合可能提高预测 Ki-67 LI 和 ATRX 突变状态的诊断性能。
常规 MRI 和功能 MRI（SWI、DWI 和 DSC-PWI）可预测 IDH 突变星形细胞瘤的 Ki-67 表达和 ATRX 突变状态，这可能有助于临床医生制定个性化治疗方案并预测患者预后。
• 多模态 MRI 的组合可能会提高预测 Ki-67 LI 和 ATRX 突变状态的诊断性能。• 与 Ki-67 LI 低的 IDH-mut 星形细胞瘤相比，Ki-67 LI 高的 IDH-mut 星形细胞瘤更有可能出现坏死、水肿、增强、边界不清、更高的 ITSS 水平、更低的 ADC 和更高的 rCBV。• 与 ATRX 突变型 IDH-mut 星形细胞瘤相比，ATRX 野生型 IDH-mut 星形细胞瘤更有可能出现水肿、更高的 ITSS 水平和更低的 ADC。
