From the Department of Radiology (K.M.K., J.S., S.H.C.), Biomedical Research Institute (C.P., C.K.P.), Department of Pathology (S.H.P.), and Department of Neurosurgery (C.K.P.), Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (K.M.K., S.H.C.); Division of Medical Statistics, Medical Research Collaborating Center, Seoul, Republic of Korea (Y.C.); and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (J.E.P., H.S.K.).
Radiology. 2024 May;311(2):e233120. doi: 10.1148/radiol.233120.
Background According to 2021 World Health Organization criteria, adult-type diffuse gliomas include glioblastoma, isocitrate dehydrogenase (IDH)-wildtype; oligodendroglioma, IDH-mutant and 1p/19q-codeleted; and astrocytoma, IDH-mutant, even when contrast enhancement is lacking. Purpose To develop and validate simple scoring systems for predicting IDH and subsequent 1p/19q codeletion status in gliomas without contrast enhancement using standard clinical MRI sequences. Materials and Methods This retrospective study included adult-type diffuse gliomas lacking contrast at contrast-enhanced MRI from two tertiary referral hospitals between January 2012 and April 2022 with diagnoses confirmed at pathology. IDH status was predicted primarily by using T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign, followed by 1p/19q codeletion prediction. A visual rating of MRI features, apparent diffusion coefficient (ADC) ratio, and relative cerebral blood volume was measured. Scoring systems were developed through univariable and multivariable logistic regressions and underwent calibration and discrimination, including internal and external validation. Results For the internal validation cohort, 237 patients were included (mean age, 44.4 years ± 14.4 [SD]; 136 male patients; 193 patients in IDH prediction and 163 patients in 1p/19q prediction). For the external validation cohort, 35 patients were included (46.1 years ± 15.3; 20 male patients; 28 patients in IDH prediction and 24 patients in 1p/19q prediction). The T2-FLAIR mismatch sign demonstrated 100% specificity and 100% positive predictive value for IDH mutation. IDH status prediction scoring system for tumors without mismatch sign included age, ADC ratio, and morphologic characteristics, whereas 1p/19q codeletion prediction for IDH-mutant gliomas included ADC ratio, cortical involvement, and mismatch sign. For IDH status and 1p/19q codeletion prediction, bootstrap-corrected areas under the receiver operating characteristic curve were 0.86 (95% CI: 0.81, 0.90) and 0.73 (95% CI: 0.65, 0.81), respectively, whereas at external validation they were 0.99 (95% CI: 0.98, 1.0) and 0.88 (95% CI: 0.63, 1.0). Conclusion The T2-FLAIR mismatch sign and scoring systems using standard clinical MRI predicted IDH and 1p/19q codeletion status in gliomas lacking contrast enhancement. © RSNA, 2024 See also the editorial by Badve and Hodges in this issue.
背景 根据 2021 年世界卫生组织标准，成人弥漫性胶质瘤包括胶质母细胞瘤、异柠檬酸脱氢酶（IDH）野生型；少突胶质细胞瘤，IDH 突变型和 1p/19q 联合缺失型；以及 IDH 突变型星形细胞瘤，即使没有对比增强。目的 开发和验证用于预测无对比增强成人弥漫性胶质瘤 IDH 和随后的 1p/19q 联合缺失状态的简单评分系统，使用标准的临床 MRI 序列。材料与方法 本回顾性研究纳入了 2012 年 1 月至 2022 年 4 月期间在两家三级转诊医院进行的无对比增强对比增强 MRI 的成人弥漫性胶质瘤患者，病理学确诊。IDH 状态主要通过使用 T2 液体衰减反转恢复（FLAIR）失配信号进行预测，然后进行 1p/19q 联合缺失预测。对 MRI 特征、表观扩散系数（ADC）比值和相对脑血容量进行视觉评分。通过单变量和多变量逻辑回归建立评分系统，并进行校准和区分，包括内部和外部验证。结果 在内部验证队列中，纳入了 237 例患者（平均年龄 44.4 岁±14.4[SD]；136 例男性患者；193 例进行 IDH 预测，163 例进行 1p/19q 预测）。在外部验证队列中，纳入了 35 例患者（46.1 岁±15.3；20 例男性患者；28 例进行 IDH 预测，24 例进行 1p/19q 预测）。T2-FLAIR 失配信号对 IDH 突变具有 100%的特异性和 100%的阳性预测值。无失配信号的肿瘤 IDH 状态预测评分系统包括年龄、ADC 比值和形态特征，而 IDH 突变型胶质瘤的 1p/19q 联合缺失预测包括 ADC 比值、皮质受累和失配信号。对于 IDH 状态和 1p/19q 联合缺失预测，Bootstrap 校正的受试者工作特征曲线下面积分别为 0.86（95%CI：0.81，0.90）和 0.73（95%CI：0.65，0.81），而在外部验证中分别为 0.99（95%CI：0.98，1.0）和 0.88（95%CI：0.63，1.0）。结论 T2-FLAIR 失配信号和使用标准临床 MRI 的评分系统预测了无对比增强成人弥漫性胶质瘤的 IDH 和 1p/19q 联合缺失状态。
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