Yamashita Koji, Murayama Ryo, Itoyama Masahiro, Kikuchi Kazufumi, Kusunoki Masaoki, Kuga Daisuke, Hatae Ryusuke, Fujioka Yutaka, Otsuji Ryosuke, Fujita Nobuhiro, Yoshimoto Koji, Ishigami Kousei, Togao Osamu
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Scientific Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Neuroradiology. 2025 Feb;67(2):291-298. doi: 10.1007/s00234-024-03538-1. Epub 2025 Jan 20.
The cortical high-flow sign has been more commonly reported in oligodendroglioma, IDH-mutant and 1p/19q-codeleted (ODG IDHm-codel) compared to diffuse glioma with IDH-wildtype or astrocytoma, IDH-mutant. Besides tumor types, higher grades of glioma might also contribute to the cortical high flow. Therefore, we investigated whether the histological cortical vascular density or CNS WHO grade was associated with the cortical high-flow sign in patients with ODG IDHm-codel.
This retrospective study consisted of pathologically confirmed 25 adult patients with ODG IDHm-codel. We implemented pseudo-continuous arterial spin labeling technique with background suppression. Subtraction images were generated from paired control and label images. Tumor-affecting cortices without intense contrast enhancement on conventional MR imaging were targeted for the determination of the cortical high-flow sign. Immunohistochemical staining of CD31 antibody was performed for the identification of vascular endothelial cells. A microscopic field of the most intense vascularization was captured in each specimen. The vessel number and the relative vascular density (%Vessel) were compared between the positive cortical high-flow sign (CHFS) and the negative cortical high-flow sign (CHFS) groups using the Mann-Whitney U test. Second, Fisher's exact test was used to compare the difference between the presence or absence of cortical high-flow sign and CNS WHO grades. Finally, the vessel number and %Vessel were compared between the CNS WHO grade 2 and grade 3 using the Mann-Whitney U test.
The vessel number and %Vessel were higher in patients with the CHFS group than in patients with CHFS group (p = 0.016 and p = 0.005, respectively). We observed no significant differences (p = 1.00) in the frequency of cortical high-flow sign between the CNS WHO grade 2 and grade 3. In addition, no significant differences are found in the vessel number and %Vessel between the CNS WHO grade 2 and grade 3 (p = 0.121 and p = 0.475, respectively).
The cortical high-flow sign on ASL, which is more commonly found in ODG IDHm-codel than in diffuse glioma with IDH-wildtype or astrocytoma, is associated with the histological cortical vascular density in patients with ODG IDHm-codel.
与异柠檬酸脱氢酶（IDH）野生型弥漫性胶质瘤或IDH突变型星形细胞瘤相比，少突胶质细胞瘤、IDH突变型且1p/19q共缺失（ODG IDHm-codel）中皮质高血流信号的报道更为常见。除肿瘤类型外，更高分级的胶质瘤也可能导致皮质高血流。因此，我们研究了ODG IDHm-codel患者的组织学皮质血管密度或中枢神经系统WHO分级是否与皮质高血流信号相关。
这项回顾性研究纳入了25例经病理证实的成年ODG IDHm-codel患者。我们采用了具有背景抑制的伪连续动脉自旋标记技术。从配对的对照图像和标记图像生成减影图像。在常规磁共振成像上无明显对比增强的肿瘤累及皮质作为确定皮质高血流信号的目标。进行CD31抗体免疫组化染色以识别血管内皮细胞。在每个标本中捕获血管化最强烈的显微镜视野。使用曼-惠特尼U检验比较皮质高血流信号阳性（CHFS）组和皮质高血流信号阴性（CHFS）组之间的血管数量和相对血管密度（%Vessel）。其次，使用Fisher精确检验比较皮质高血流信号的有无与中枢神经系统WHO分级之间的差异。最后，使用曼-惠特尼U检验比较中枢神经系统WHO 2级和3级之间的血管数量和%Vessel。
CHFS组患者的血管数量和%Vessel高于CHFS组患者（分别为p = 0.016和p = 0.005）。我们观察到中枢神经系统WHO 2级和3级之间皮质高血流信号频率无显著差异（p = 1.00）。此外，中枢神经系统WHO 2级和3级之间的血管数量和%Vessel也无显著差异（分别为p = 0.121和p = 0.475）。
ASL上的皮质高血流信号在ODG IDHm-codel中比在IDH野生型弥漫性胶质瘤或星形细胞瘤中更常见，它与ODG IDHm-codel患者的组织学皮质血管密度相关。
