Liu Xinlong, Hou Zonggang, He Qifeng, Zhao Hongfang, Sun Shengjun, Hao Shuyu, Xie Jian
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2025 May 1;15(5):4655-4668. doi: 10.21037/qims-2024-2704. Epub 2025 Apr 28.
Iron is associated with the pathophysiology of gliomas. The measurement of brain iron levels plays a vital role in defining the pathophysiologic changes caused by gliomas. This study aimed to analyze the effect of gliomas with different histopathology and molecular characteristics on deep gray matter (DGM) iron content and the relationship between DGM iron content and cognition in glioma patients (PT).
In this retrospective study, we included 81 PT, categorized according to different histopathology and molecular characteristics, and 30 age- and gender-matched healthy controls (HC). Brain quantitative susceptibility mapping (QSM) maps were computed from three-dimensional (3D) multi-echo gradient-echo data using Laplacian-based phase unwrapping, a variational sharpening (V-SHARP) background field correction and the streaking artifacts reduction (STAR)-QSM method. ITK-SNAP was used to measure the susceptibility values reflecting the iron content in the regions of interest. Differences in DGM magnetic susceptibility between groups were compared. Pearson's correlation analysis assessed the relationship between DGM magnetic susceptibility and Montreal Cognitive Assessment (MoCA).
Compared to HC, PT showed higher DGM magnetic susceptibility. QSM analysis exhibited higher DGM magnetic susceptibility in high-grade gliomas (HGG) than low-grade gliomas (LGG). Isocitrate dehydrogenase (IDH) wild-type gliomas showed higher magnetic susceptibility than IDH mutant-type in the putamen [IDH mutant-type: interquartile range (IQR), 0.052, 0.019 ppm IDH wild-type: IQR, 0.062, 0.015 ppm, P=0.015]. A higher Ki-67 index also correlated with higher magnetic susceptibility in the putamen (high Ki-67 index group: IQR, 0.063, 0.019 ppm low Ki-67 index group: IQR, 0.052, 0.016 ppm, P=0.005). The PT group had significantly lower MoCA scores than the HC group (patients group HC group: 22.30±4.92 24.70±2.20, P=0.021). There was a negative correlation between MoCA scores and DGM magnetic susceptibility.
The DGM iron content, as measured by QSM, was higher in PT than in HC and correlated with tumor grade. Cognitive decline is associated with increased DGM iron content in PT. The DGM iron content could be a potential biomarker in glioma differentiation and prognosis.
铁与胶质瘤的病理生理学相关。脑铁水平的测量在确定胶质瘤引起的病理生理变化中起着至关重要的作用。本研究旨在分析具有不同组织病理学和分子特征的胶质瘤对深部灰质（DGM）铁含量的影响以及胶质瘤患者（PT）中DGM铁含量与认知之间的关系。
在这项回顾性研究中，我们纳入了81例根据不同组织病理学和分子特征分类的PT，以及30例年龄和性别匹配的健康对照（HC）。使用基于拉普拉斯相位展开、变分锐化（V-SHARP）背景场校正和条纹伪影减少（STAR）-QSM方法，从三维（3D）多回波梯度回波数据计算脑定量磁化率映射（QSM）图。使用ITK-SNAP测量反映感兴趣区域铁含量的磁化率值。比较各组之间DGM磁化率的差异。Pearson相关性分析评估DGM磁化率与蒙特利尔认知评估（MoCA）之间的关系。
与HC相比，PT表现出更高的DGM磁化率。QSM分析显示高级别胶质瘤（HGG）中的DGM磁化率高于低级别胶质瘤（LGG）。在壳核中，异柠檬酸脱氢酶（IDH）野生型胶质瘤的磁化率高于IDH突变型[IDH突变型：四分位数间距（IQR），0.052，0.019 ppm；IDH野生型：IQR，0.062，0.015 ppm，P=0.015]。较高的Ki-67指数也与壳核中较高的磁化率相关（高Ki-67指数组：IQR，0.063，0.019 ppm；低Ki-67指数组：IQR，0.052，0.016 ppm，P=0.005）。PT组的MoCA评分显著低于HC组（患者组对HC组：22.30±4.92对24.70±2.20，P=0.021）。MoCA评分与DGM磁化率之间存在负相关。
通过QSM测量，PT中的DGM铁含量高于HC，且与肿瘤分级相关。认知功能下降与PT中DGM铁含量增加有关。DGM铁含量可能是胶质瘤分化和预后的潜在生物标志物。
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