Departments of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Departments of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Neuroradiology. 2023 Aug;65(8):1205-1213. doi: 10.1007/s00234-023-03177-y. Epub 2023 Jun 13.
Isocitrate dehydrogenase (IDH)-wildtype diffuse astrocytic glioma with telomerase reverse transcriptase (TERT) promoter mutation is defined as glioblastoma by the WHO 2021 criteria, revealing that TERT promotor mutation is highly associated with tumor aggressiveness. The aim of this study was to identify features from MR spectroscopy (MRS) and multi-exponential models of DWI distinguishing wild-type TERT (TERTw) from TERT promoter mutation (TERTm) in IDH-wildtype diffuse astrocytic glioma.
Participants comprised 25 adult patients with IDH-wildtype diffuse astrocytic glioma. Participants were classified into TERTw and TERTm groups. Point-resolved spectroscopy sequences were used for MRS data acquisition. DWI was performed with 13 different b-factors. Peak height ratios of NAA/Cr and Cho/Cr were calculated from MRS data. Mean apparent diffusion coefficient (ADC), perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), distributed diffusion coefficient (DDC), and heterogeneity index (α) were obtained using multi-exponential models from DWI data. Each parameter was compared between TERTw and TERTm using the Mann-Whitney U test. Correlations between parameters derived from MRS and DWI were also evaluated.
NAA/Cr and Cho/Cr were both higher for TERTw than for TERTm. The α of TERTw was smaller than that of TERTm, while the f of TERTw was higher than that of TERTm. NAA/Cr correlated negatively with α, but not with other DWI parameters. Cho/Cr did not show significant correlations with any DWI parameters.
The combination of NAA/Cr and α may have merit in clinical situation to predict the TERT mutation status of IDH-wildtype diffuse astrocytic glioma without intense enhancement.
根据世界卫生组织 2021 年标准，端粒酶逆转录酶 (TERT) 启动子突变的异柠檬酸脱氢酶 (IDH)-野生型弥漫性星形细胞瘤被定义为胶质母细胞瘤，这表明 TERT 启动子突变与肿瘤侵袭性高度相关。本研究旨在确定磁共振波谱 (MRS) 和 DWI 多指数模型中的特征，以区分 IDH 野生型弥漫性星形细胞瘤中的野生型 TERT (TERTw) 和 TERT 启动子突变 (TERTm)。
参与者包括 25 名 IDH 野生型弥漫性星形细胞瘤的成年患者。参与者被分为 TERTw 和 TERTm 组。使用点分辨波谱序列采集 MRS 数据。DWI 采用 13 种不同的 b 值进行。从 MRS 数据中计算出 NAA/Cr 和 Cho/Cr 的峰高比。使用 DWI 数据的多指数模型获得平均表观扩散系数 (ADC)、灌注分数 (f)、扩散系数 (D)、伪扩散系数 (D*)、分布扩散系数 (DDC) 和异质性指数 (α)。使用 Mann-Whitney U 检验比较 TERTw 和 TERTm 之间的每个参数。还评估了来自 MRS 和 DWI 的参数之间的相关性。
TERTw 的 NAA/Cr 和 Cho/Cr 均高于 TERTm。TERTw 的 α 小于 TERTm，而 TERTw 的 f 高于 TERTm。NAA/Cr 与 α 呈负相关，但与其他 DWI 参数无关。Cho/Cr 与任何 DWI 参数均无显著相关性。
在没有强烈增强的情况下，NAA/Cr 和 α 的组合可能在临床情况下具有预测 IDH 野生型弥漫性星形细胞瘤 TERT 突变状态的优势。
