考虑空间和时间异质性，在治疗前和治疗后阶段使用扩散加权磁共振成像（DWI）和灌注加权磁共振成像（PWI）对成人型弥漫性胶质瘤进行基于影像的分子特征分析

Imaging-Based Molecular Characterization of Adult-Type Diffuse Glioma Using Diffusion and Perfusion MRI in Pre- and Post-Treatment Stage Considering Spatial and Temporal Heterogeneity.

作者信息

Roh Yun Hwa, Cheong E-Nae, Park Ji Eun, Choi Yangsean, Jung Seung Chai, Song Sang Woo, Kim Young-Hoon, Hong Chang-Ki, Kim Jeong Hoon, Kim Ho Sung

机构信息

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

出版信息

J Magn Reson Imaging. 2025 Aug;62(2):468-479. doi: 10.1002/jmri.29781. Epub 2025 Apr 8.

DOI:10.1002/jmri.29781

PMID:40197845

Abstract

BACKGROUND

Imaging-based molecular characterization is important for identifying treatment targets in adult-type diffuse gliomas.

PURPOSE

To assess isocitrate dehydrogenase (IDH) mutation and epidermal growth factor receptor (EGFR) amplification status in primary and recurrent gliomas using diffusion and perfusion MRI, addressing spatial and temporal heterogeneity.

STUDY TYPE

Retrospective.

SUBJECTS

Three-hundred and twelve newly diagnosed (cross-sectional set, 57.9 ± 13.2 years, 52.2% male, 235 IDH-wildtype, 71 EGFR-amplified) and 38 recurrent (longitudinal set, 53.1 ± 13.4 years, 44.7% male, 30 IDH-wildtype, 13 EGFR-amplified) adult-type diffuse glioma patients.

FIELD STRENGTH/SEQUENCE: 3.0T; diffusion weighted and dynamic susceptibility contrast-perfusion weighted imaging.

ASSESSMENT

Radiomics features from contrast-enhancing tumors (CET) and non-enhancing lesions (NEL) were extracted from apparent diffusion coefficient and perfusion maps. Spatial heterogeneity was assessed using intersection and Bhattacharyya distance between CET and NEL. Stable imaging features were identified in patients with unchanged genetic profiles in the longitudinal set. The "best model," using features from the cross-sectional set (n = 312), and the "concordant model," using stable features identified in the longitudinal set (n = 38), were constructed using the LASSO for IDH and EGFR status.

STATISTICAL TESTS

The area under the receiver-operating-characteristic curve (AUC).

RESULTS

For IDH mutations, both best and concordant models demonstrated high AUCs in the cross-sectional set (0.936; 95% confidence interval [CI]: 0.903-0.969 and 0.964 [0.943-0.986], respectively). Only the concordant model maintained strong performance in recurrent tumors (AUC, 0.919 vs. 0.656). For EGFR amplification in IDH-wildtype, the best and concordant models showed AUCs of 0.821 (95% CI: 0.761-0.881) and 0.746 (95% CI: 0.675-0.817) in newly diagnosed gliomas, but poor performance in recurrent tumors with AUCs of 0.503 (95% CI: 0.34-0.665) and 0.518 (95% CI: 0.357-0.678).

DATA CONCLUSION

Diffusion and perfusion MRI characterized IDH status in both newly diagnosed and recurrent gliomas, but showed limited diagnostic performance for EGFR, especially for recurrent tumors.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 3.

摘要

背景

基于成像的分子特征分析对于识别成人型弥漫性胶质瘤的治疗靶点很重要。

目的

利用扩散加权成像和灌注加权成像评估原发性和复发性胶质瘤中异柠檬酸脱氢酶（IDH）突变和表皮生长因子受体（EGFR）扩增状态，探讨空间和时间异质性。

研究类型

回顾性研究。

研究对象

312例新诊断的（横断面组，年龄57.9±13.2岁，男性占52.2%，235例IDH野生型，71例EGFR扩增）和38例复发的（纵向组，年龄53.1±13.4岁，男性占44.7%，30例IDH野生型，13例EGFR扩增）成人型弥漫性胶质瘤患者。

场强/序列：3.0T；扩散加权成像和动态磁敏感对比灌注加权成像。

评估

从表观扩散系数图和灌注图中提取对比增强肿瘤（CET）和非增强病变（NEL）的影像组学特征。利用CET和NEL之间的交集和巴氏距离评估空间异质性。在纵向组中基因谱未改变的患者中识别稳定的影像特征。使用LASSO构建用于IDH和EGFR状态的“最佳模型”（使用横断面组的特征，n = 312）和“一致性模型”（使用纵向组中识别的稳定特征，n = 38）。

统计检验

受试者操作特征曲线下面积（AUC）。

结果

对于IDH突变，最佳模型和一致性模型在横断面组中均显示出较高的AUC（分别为0.936；95%置信区间[CI]：0.903 - 0.969和0.964[0.943 - 0.986]）。只有一致性模型在复发肿瘤中保持了较强的性能（AUC，0.919对0.656）。对于IDH野生型中的EGFR扩增，最佳模型和一致性模型在新诊断的胶质瘤中显示的AUC分别为0.821（95%CI：0.761 - 0.881）和0.746（95%CI：0.675 - 0.817），但在复发肿瘤中的性能较差，AUC分别为0.503（95%CI：0.34 - 0.665）和0.518（95%CI：0.357 - 0.678）。