Radiology Department, Institut deDiagnòstic Per LaImatge (IDI), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Neurooncology Unit, Institutd'InvestigacióBiomèdica deBellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Eur Radiol. 2024 Apr;34(4):2174-2182. doi: 10.1007/s00330-023-10138-9. Epub 2023 Sep 23.
The 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors prioritizes isocitrate dehydrogenase (IDH) mutation to define tumor types in diffuse gliomas, in contrast to the 2016 classification, which prioritized histological features. Our objective was to investigate the influence of this change in the performance of proton MR spectroscopy (H-MRS) in segregating high-grade diffuse astrocytoma subgroups.
Patients with CNS WHO grade 3 and 4 diffuse astrocytoma, known IDH mutation status, and available H-MRS were retrospectively retrieved and divided into 4 groups based on IDH mutation status and histological grade. Differences in H-MRS between groups were analyzed with the Kruskal-Wallis test. The points on the spectrum that showed the greatest differences were chosen to evaluate the performance of H-MRS in discriminating between grades 3 and 4 tumors (WHO 2016 defined), and between IDH-mutant and IDH-wildtype tumors (WHO 2021). ROC curves were constructed with these points, and AUC values were calculated and compared.
The study included 223 patients with high-grade diffuse astrocytoma. Discrimination between IDH-mutant and IDH-wildtype tumors showed higher AUC values (highest AUC short TE, 0.943; long TE, 0.864) and more noticeable visual differences than the discrimination between grade 3 and 4 tumors (short TE, 0.885; long TE, 0.838).
Our findings suggest that H-MRS is more applicable to classify high-grade astrocytomas defined with the 2021 criteria. Improved metabolomic robustness and more homogeneous groups yielded better tumor type discrimination by H-MRS with the new criteria.
The 2021 World Health Organization classification of brain tumors empowers molecular criteria to improve tumor characterization. This derives in greater segregation of high-grade diffuse astrocytoma subgroups by MR spectroscopy and warrants further development of brain tumor classification tools with spectroscopy.
• The new 2021 updated World Health Organization classification of central nervous system tumors maximizes the role of molecular diagnosis in the classification of brain tumors. • Proton MR spectroscopy performs better to segregate high-grade astrocytoma subgroups when defined with the new criteria. • The study provides additional evidence of improved metabolic characterization of brain tumor subgroups with the new criteria.
2021 年世界卫生组织（WHO）中枢神经系统（CNS）肿瘤分类将异柠檬酸脱氢酶（IDH）突变作为弥漫性胶质瘤肿瘤类型的定义标准，与 2016 年的分类标准不同，后者将组织学特征作为优先考虑。我们的目的是研究这一变化对质子磁共振波谱（H-MRS）在区分高级别弥漫性星形细胞瘤亚组中的表现的影响。
回顾性检索了已知 IDH 突变状态且有 H-MRS 检查结果的 CNS 分级 3 级和 4 级弥漫性星形细胞瘤患者，根据 IDH 突变状态和组织学分级分为 4 组。采用 Kruskal-Wallis 检验分析组间 H-MRS 差异。选择谱线上差异最大的点来评估 H-MRS 在区分 3 级和 4 级肿瘤（2016 年 WHO 定义）和 IDH 突变型和 IDH 野生型肿瘤（2021 年 WHO 定义）方面的性能。使用这些点构建 ROC 曲线，并计算和比较 AUC 值。
本研究纳入了 223 例高级别弥漫性星形细胞瘤患者。IDH 突变型和 IDH 野生型肿瘤的鉴别具有更高的 AUC 值（最短 TE 的最高 AUC 值为 0.943，长 TE 的最高 AUC 值为 0.864）和更明显的视觉差异，优于 3 级和 4 级肿瘤的鉴别（最短 TE 的 AUC 值为 0.885，长 TE 的 AUC 值为 0.838）。
我们的研究结果表明，H-MRS 更适用于用 2021 年标准分类高级别星形细胞瘤。新分类标准下，代谢组学的稳健性提高，组间更均匀，H-MRS 对肿瘤类型的鉴别能力更好。
2021 年世界卫生组织脑肿瘤分类将分子标准纳入其中，以提高肿瘤特征的描述能力。这使得高级别弥漫性星形细胞瘤亚组通过磁共振波谱得到更好的分离，并需要进一步开发基于波谱的脑肿瘤分类工具。
2021 年更新的世界卫生组织中枢神经系统肿瘤分类最大限度地提高了分子诊断在脑肿瘤分类中的作用。
质子磁共振波谱（H-MRS）在使用新标准定义时，对高级别星形细胞瘤亚组的分离效果更好。
该研究为使用新标准对脑肿瘤亚组进行代谢特征的改善提供了更多证据。
