Wang Xijie, Jiang Haihui, Li Mingxiao, Zhang Xiaokang, Li Haoyi, Li Ming, Ren Xiaohui, Zhang Shouzan, Tong Siqi, Liu Anzhu, Ren Qingsen, Cui Yong, Lin Song
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing.
2Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing.
J Neurosurg. 2025 Apr 4;143(2):340-351. doi: 10.3171/2024.11.JNS242017. Print 2025 Aug 1.
The aim of this study was to evaluate the cortical nonenhancing tumor infiltration (CONTIN) sign as a predictive imaging biomarker for IDH-mutant gliomas, including diffuse gliomas with and without contrast enhancement.
Imaging data were collected from patients with diffuse gliomas (grades 2-4) at Beijing Tiantan Hospital (BTH) from January 2019 to December 2021 (training set, n = 526) and from the University of California, San Francisco, preoperative diffuse glioma MRI dataset (UCSF PDGM; validation set, n = 501). Two independent reviewers assessed the CONTIN sign and other radiological features to develop a diagnostic strategy.
Interrater agreement for the CONTIN sign was almost perfect (κ = 0.812). In the BTH cohort, the prevalence of the CONTIN sign in IDH-mutant gliomas was 90.1% overall, with a rate of 92.2% (106/115) in contrast-enhancing gliomas and 88.9% (168/189) in nonenhancing gliomas. In the UCSF PDGM cohort, the overall prevalence was 85.4%, with 81.4% in contrast-enhancing gliomas and 88.3% in nonenhancing gliomas. In contrast-enhancing gliomas, the CONTIN sign significantly improved sensitivity compared with the T2-FLAIR mismatch (T2FMM) sign, with an increase from 14.8% to 92.2% in the BTH cohort and from 23.3% to 81.4% in the UCSF PDGM cohort. Additionally, the CONTIN sign had a high specificity (82.8% in the BTH cohort, 87.4% in the UCSF PDGM cohort) and negative predictive value (94.6% in the BTH cohort, 97.6% in the UCSF PDGM cohort). By integrating the CONTIN sign with T2FMM, contrast enhancement, age at diagnosis, and other features, a reliable diagnostic protocol for IDH-mutant gliomas was established.
The CONTIN sign was a robust imaging biomarker for identifying IDH mutation status in diffuse glioma, particularly for those with contrast enhancement. Preoperative knowledge of IDH mutation status can enhance patient counseling and inform treatment decision-making.
本研究旨在评估皮质无强化肿瘤浸润（CONTIN）征作为异柠檬酸脱氢酶（IDH）突变型胶质瘤的预测性影像生物标志物，包括有和无对比增强的弥漫性胶质瘤。
收集2019年1月至2021年12月在北京天坛医院（BTH）的弥漫性胶质瘤（2 - 4级）患者的影像数据（训练集，n = 526）以及来自加利福尼亚大学旧金山分校的术前弥漫性胶质瘤MRI数据集（UCSF PDGM；验证集，n = 501）。两名独立的评估者评估CONTIN征及其他放射学特征以制定诊断策略。
CONTIN征的评估者间一致性几乎为完美（κ = 0.812）。在BTH队列中，IDH突变型胶质瘤中CONTIN征的总体患病率为90.1%，其中强化型胶质瘤的患病率为92.2%（106/115），非强化型胶质瘤的患病率为88.9%（168/189）。在UCSF PDGM队列中，总体患病率为85.4%，强化型胶质瘤的患病率为81.4%，非强化型胶质瘤的患病率为88.3%。在强化型胶质瘤中，与T2液体衰减反转恢复（T2-FLAIR）不匹配（T2FMM）征相比，CONTIN征显著提高了敏感性，在BTH队列中从14.8%增至92.2%，在UCSF PDGM队列中从23.3%增至81.4%。此外，CONTIN征具有高特异性（BTH队列中为82.8%，UCSF PDGM队列中为87.4%）和阴性预测值（BTH队列中为94.6%，UCSF PDGM队列中为97.6%）。通过将CONTIN征与T2FMM、对比增强、诊断时年龄及其他特征相结合，建立了一种可靠的IDH突变型胶质瘤诊断方案。
CONTIN征是用于识别弥漫性胶质瘤中IDH突变状态的可靠影像生物标志物，尤其对于有对比增强的患者。术前了解IDH突变状态可加强患者咨询并为治疗决策提供依据。
