Yadav Virendra Kumar, Sharma Shalini, Maurya Satyajit, Singh Rakesh K, Saini Jitendra, Jain Preeti, Patir Rana, Ahlawat Sunita, Das Sumanta, Vaishya Sandeep, Agarwal Sumeet, Singh Anup, Gupta Rakesh K
Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.
Department of Radiology, Fortis Memorial Research Institute, Gurugram, India.
J Magn Reson Imaging. 2025 Jul;62(1):258-270. doi: 10.1002/jmri.29695. Epub 2025 Jan 9.
BACKGROUND: Isocitrate dehydrogenase (IDH) wild-type (IDH) glioblastomas (GB) are more aggressive and have a poorer prognosis than IDH mutant (IDH) tumors, emphasizing the need for accurate preoperative differentiation. However, a distinct imaging biomarker for differentiation mostly lacking. Intratumoral thrombosis has been reported as a histopathological biomarker for GB. PURPOSE: To evaluate the fragmented intratumoral thrombosed microvasculature (FTV) signs on susceptibility-weighted imaging (SWI) for distinguishing IDH and IDH tumors. STUDY TYPE: Retrospective. SUBJECTS: Ninety-seven treatment-naïve patients with histopathologically confirmed IDH GB (54 males, 26 females) and IDH grade 4 astrocytoma (13 males, 4 females). FIELD STRENGTH/SEQUENCE: 3-T, SWI, fluid-attenuated-inversion-recovery (FLAIR), T-weighted, T-weighted, PD-weighted, post-contrast T-weighted and dynamic-contrast-enhanced (DCE)-MRI. ASSESSMENT: SWI data were evaluated by three experienced neuroradiologists (S.S., 11 years; J.S., 15 years; R.K.G., 40 years of experience), who assessed FTV presence in necrotic and peri-necrotic regions. FTV was identified as intratumoral susceptibility signal having minimal or no interslice connections. Quantitative DCE-MRI parameters were derived using first-pass-analysis and extended Tofts model. FLAIR abnormal, contrast-enhancing, and necrotic regions were segmented using in-house developed U-Net architecture. STATISTICAL TESTS: Fleiss' Kappa, Cohen's Kappa, Shapiro-Wilk test, t tests or Mann-Whitney U test, receiver-operating characteristic (ROC) analysis, confusion matrix. A P-value <0.05 was considered statistically significant. RESULTS: Fleiss' kappa test provided 91% inter-rater agreement, and Cohen's kappa provided intrarater agreement ranged from 81% to 97%. The raters' accuracy in distinguishing IDH from IDH ranged from 92% to 94%. Some of the quantitative DCE-MRI parameters (CBV, Ve, and K) provided statistically significant differences in differentiating IDH and IDH. K demonstrated 80.3% sensitivity and 81.2% specificity, with ROC analysis showing an AUC of 0.77. DATA CONCLUSION: FTV signs in necrotic and peri-necrotic regions on SWI demonstrated a high accuracy in distinguishing IDH from IDH. Qualitative assessment of FTV signs showed almost perfect inter-rater and intrarater agreement. Quantitative DCE-MRI metrics also showed statistically significant differentiation of IDH and IDH. PLAIN LANGUAGE SUMMARY: This study demonstrates that preoperative imaging, particularly the visualization of the fragmented thrombosed vasculature (FTV) sign on susceptibility-weighted imaging (SWI), effectively differentiates isocitrate dehydrogenase (IDH) wild-type (IDH) glioblastoma (GB) from IDH mutant (IDH) grade 4 astrocytomas. Over 90% of IDH GB patients displayed the FTV sign, a specific imaging biomarker absent in IDH cases. Perfusion parameters such as cerebral blood volume, Ve, and K were elevated in IDH gliomas, reflecting distinct vascular profiles. SWI offers a noninvasive and accurate diagnostic method, overcoming limitations of histopathology. Despite limitations like unequal sample sizes and retrospective analysis, this study underscores the clinical potential of SWI in improving glioma characterization and aiding treatment planning. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.
背景:异柠檬酸脱氢酶(IDH)野生型(IDH)胶质母细胞瘤(GB)比IDH突变型(IDH)肿瘤更具侵袭性,预后更差,这凸显了术前准确鉴别的必要性。然而,目前大多缺乏用于鉴别的独特影像生物标志物。瘤内血栓形成已被报道为GB的一种组织病理学生物标志物。 目的:评估磁敏感加权成像(SWI)上的瘤内血栓微血管(FTV)碎裂征象,以区分IDH和IDH肿瘤。 研究类型:回顾性研究。 研究对象:97例未经治疗且经组织病理学确诊的IDH型GB患者(男54例,女26例)以及IDH 4级星形细胞瘤患者(男13例,女4例)。 场强/序列:3-T,SWI、液体衰减反转恢复序列(FLAIR)、T加权像、T加权像、质子密度加权像、增强后T加权像以及动态对比增强(DCE)-MRI。 评估:由三位经验丰富的神经放射科医生(S.S.,11年经验;J.S.,15年经验;R.K.G.,40年经验)评估SWI数据,他们评估坏死及坏死周围区域FTV的存在情况。FTV被定义为瘤内磁敏感信号,层间连接最少或无连接。使用首过分析法和扩展Tofts模型得出定量DCE-MRI参数。使用内部开发的U-Net架构对FLAIR序列上的异常区域、强化区域和坏死区域进行分割。 统计检验:Fleiss卡方检验、Cohen卡方检验、Shapiro-Wilk检验、t检验或Mann-Whitney U检验、受试者工作特征(ROC)分析、混淆矩阵。P值<0.05被认为具有统计学意义。 结果:Fleiss卡方检验的评分者间一致性为91%,Cohen卡方检验的评分者内一致性为81%至97%。评分者区分IDH和IDH的准确率为92%至94%。一些定量DCE-MRI参数(脑血容量、Ve和K)在区分IDH和IDH方面具有统计学显著差异。K的敏感性为80.3%,特异性为81.2%,ROC分析显示曲线下面积(AUC)为0.77。 数据结论:SWI上坏死及坏死周围区域的FTV征象在区分IDH和IDH方面具有较高的准确性。FTV征象的定性评估显示评分者间和评分者内一致性几乎完美。定量DCE-MRI指标在区分IDH和IDH方面也显示出统计学显著差异。 通俗语言总结:本研究表明,术前影像检查,尤其是磁敏感加权成像(SWI)上瘤内血栓微血管(FTV)碎裂征象的可视化,可有效区分异柠檬酸脱氢酶(IDH)野生型(IDH)胶质母细胞瘤(GB)和IDH突变型(IDH)4级星形细胞瘤。超过90%的IDH型GB患者显示出FTV征象,这是IDH病例中不存在的一种特异性影像生物标志物。IDH胶质瘤的灌注参数如脑血容量、Ve和K升高,反映出不同的血管特征。SWI提供了一种无创且准确诊断方法,克服了组织病理学的局限性。尽管存在样本量不等和回顾性分析等局限性,但本研究强调了SWI在改善胶质瘤特征描述及辅助治疗规划方面的临床潜力。 证据级别:4级 技术效能:2级
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