2HG MRS 和 IVIM 整合对胶质瘤 IDH 突变状态预测的诊断效率与单一参数的比较：一项回顾性研究。
The diagnostic efficiency of integration of 2HG MRS and IVIM versus individual parameters for predicting IDH mutation status in gliomas in clinical scenarios: A retrospective study.
机构信息
Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
Department of Radiology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan Province, China.
出版信息
J Neurooncol. 2024 Apr;167(2):305-313. doi: 10.1007/s11060-024-04609-2. Epub 2024 Feb 29.
PURPOSE
Currently, there remains a scarcity of established preoperative tests to accurately predict the isocitrate dehydrogenase (IDH) mutation status in clinical scenarios, with limited research has explored the potential synergistic diagnostic performance among metabolite, perfusion, and diffusion parameters. To address this issue, we aimed to develop an imaging protocol that integrated 2-hydroxyglutarate (2HG) magnetic resonance spectroscopy (MRS) and intravoxel incoherent motion (IVIM) by comprehensively assessing metabolic, cellular, and angiogenic changes caused by IDH mutations, and explored the diagnostic efficiency of this imaging protocol for predicting IDH mutation status in clinical scenarios.
METHODS
Patients who met the inclusion criteria were categorized into two groups: IDH-wild type (IDH-WT) group and IDH-mutant (IDH-MT) group. Subsequently, we quantified the 2HG concentration, the relative apparent diffusion coefficient (rADC), the relative true diffusion coefficient value (rD), the relative pseudo-diffusion coefficient (rD*) and the relative perfusion fraction value (rf). Intergroup differences were estimated using t-test and Mann-Whitney U test. Finally, we performed receiver operating characteristic (ROC) curve and DeLong's test to evaluate and compare the diagnostic performance of individual parameters and their combinations.
RESULTS
64 patients (female, 21; male, 43; age, 47.0 ± 13.7 years) were enrolled. Compared with IDH-WT gliomas, IDH-MT gliomas had higher 2HG concentration, rADC and rD (P < 0.001), and lower rD* (P = 0.013). The ROC curve demonstrated that 2HG + rD + rD* exhibited the highest areas under curve (AUC) value (0.967, 95%CI 0.889-0.996) for discriminating IDH mutation status. Compared with each individual parameter, the predictive efficiency of 2HG + rADC + rD* and 2HG + rD + rD* shows a statistically significant enhancement (DeLong's test: P < 0.05).
CONCLUSIONS
The integration of 2HG MRS and IVIM significantly improves the diagnostic efficiency for predicting IDH mutation status in clinical scenarios.
目的
目前，临床上缺乏准确预测异柠檬酸脱氢酶（IDH）突变状态的既定术前检测手段，相关研究也很少探索代谢物、灌注和弥散参数之间的潜在协同诊断性能。为解决这一问题，我们旨在通过全面评估 IDH 突变引起的代谢、细胞和血管生成变化，开发一种整合 2-羟戊二酸（2HG）磁共振波谱（MRS）和体素内不相干运动（IVIM）的成像方案，并探讨该成像方案对预测临床情景中 IDH 突变状态的诊断效率。
方法
符合纳入标准的患者被分为两组：IDH 野生型（IDH-WT）组和 IDH 突变型（IDH-MT）组。随后，我们对 2HG 浓度、相对表观扩散系数（rADC）、相对真实扩散系数值（rD）、相对假性扩散系数（rD*）和相对灌注分数值（rf）进行量化。使用 t 检验和曼-惠特尼 U 检验估计组间差异。最后，我们进行了受试者工作特征（ROC）曲线和德龙检验，以评估和比较单个参数及其组合的诊断性能。
结果
共纳入 64 名患者（女性 21 名，男性 43 名，年龄 47.0±13.7 岁）。与 IDH-WT 胶质瘤相比，IDH-MT 胶质瘤的 2HG 浓度、rADC 和 rD 更高（P<0.001），rD更低（P=0.013）。ROC 曲线表明，2HG+rD+rD鉴别 IDH 突变状态的曲线下面积（AUC）最高（0.967，95%CI 0.889-0.996）。与单个参数相比，2HG+rADC+rD和 2HG+rD+rD的预测效率均有统计学意义上的提高（德龙检验：P<0.05）。
结论
2HG MRS 和 IVIM 的整合显著提高了临床情景中预测 IDH 突变状态的诊断效率。
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