Cho Nicholas S, Sanvito Francesco, Le Viên Lam, Oshima Sonoko, Teraishi Ashley, Yao Jingwen, Telesca Donatello, Raymond Catalina, Pope Whitney B, Nghiemphu Phioanh L, Lai Albert, Salamon Noriko, Cloughesy Timothy F, Ellingson Benjamin M
Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA.
Neuroradiology. 2024 Dec;66(12):2153-2162. doi: 10.1007/s00234-024-03475-z. Epub 2024 Oct 8.
This study compared the classification performance of normalized apparent diffusion coefficient (nADC) with percentage T2-FLAIR mismatch-volume (%T2FM-volume) for differentiating between IDH-mutant astrocytoma (IDHm-A) and other glioma molecular subtypes.
A total of 105 non-enhancing gliomas were studied. T2-FLAIR digital subtraction maps were used to identify T2FM and T2-FLAIR non-mismatch (T2FNM) subregions within tumor volumes of interest (VOIs). Median nADC from the whole tumor, T2FM, and T2NFM subregions and %T2FM-volume were obtained. IDHm-A classification analyses using receiver-operating characteristic curves and multiple logistic regression were performed in addition to exploratory survival analyses.
T2FM subregions had significantly higher nADC than T2FNM subregions within IDHm-A with ≥ 25% T2FM-volume (P < 0.0001). IDHm-A with ≥ 25% T2FM-volume demonstrated significantly higher whole tumor nADC compared to IDHm-A with < 25% T2FM-volume (P < 0.0001), and both IDHm-A subgroups demonstrated significantly higher nADC compared to IDH-mutant oligodendroglioma and IDH-wild-type gliomas (P < 0.05). For classification of IDHm-A vs. other gliomas, the area under curve (AUC) of nADC was significantly greater compared to the AUC of %T2FM-volume (P = 0.01, nADC AUC = 0.848, %T2FM-volume AUC = 0.714) along with greater sensitivity. In exploratory survival analyses within IDHm-A, %T2FM-volume was not associated with overall survival (P = 0.2), but there were non-significant trends for nADC (P = 0.07) and tumor volume (P = 0.051).
T2-FLAIR subtraction maps are useful for characterizing IDHm-A imaging characteristics. nADC outperforms %T2FM-volume for classifying IDHm-A amongst non-enhancing gliomas with preserved high specificity and increased sensitivity, which may be related to inherent diffusivity differences regardless of T2FM. In line with previous findings on visual T2FM-sign, quantitative %T2FM-volume may not be prognostic.
本研究比较了标准化表观扩散系数（nADC）与T2-FLAIR错配体积百分比（%T2FM-体积）在区分异柠檬酸脱氢酶（IDH）突变型星形细胞瘤（IDHm-A）和其他胶质瘤分子亚型方面的分类性能。
共研究了105例无强化的胶质瘤。利用T2-FLAIR数字减法图在感兴趣的肿瘤体积（VOI）内识别T2FM和T2-FLAIR非错配（T2FNM）亚区域。获取整个肿瘤、T2FM和T2NFM亚区域的nADC中位数以及%T2FM-体积。除了探索性生存分析外，还使用受试者工作特征曲线和多元逻辑回归进行IDHm-A分类分析。
在T2FM体积≥25%的IDHm-A中，T2FM亚区域的nADC显著高于T2FNM亚区域（P<0.0001）。与T2FM体积<25%的IDHm-A相比，T2FM体积≥25%的IDHm-A的整个肿瘤nADC显著更高（P<0.0001），并且与IDH突变型少突胶质细胞瘤和IDH野生型胶质瘤相比，这两个IDHm-A亚组的nADC均显著更高（P<0.05）。对于IDHm-A与其他胶质瘤的分类，nADC的曲线下面积（AUC）显著大于%T2FM-体积的AUC（P=0.01，nADC AUC=0.848，%T2FM-体积AUC=0.714），且敏感性更高。在IDHm-A的探索性生存分析中，%T2FM-体积与总生存期无关（P=0.2），但nADC（P=0.07）和肿瘤体积（P=0.051）有不显著的趋势。
T2-FLAIR减法图有助于表征IDHm-A的影像学特征。在对无强化的胶质瘤进行IDHm-A分类时，nADC优于%T2FM-体积，具有较高的特异性和增加的敏感性，这可能与无论T2FM如何的固有扩散率差异有关。与先前关于视觉T2FM信号的研究结果一致，定量的%T2FM-体积可能不具有预后价值。
