Tudela Martínez José Ignacio, Vázquez Sáez Victoria, Carbonell Guillermo, Rodrigo Lara Héctor, Guzmán-Aroca Florentina, Berna Mestre Juan de Dios
Department of Dermatology, Dentistry, Radiology and Physical Medicine, Faculty of Medicine, University of Murcia, Av. Buenavista, 32, 30120 El Palmar, Spain.
Radiology Department, Virgen de la Arrixaca University Hospital, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Spain.
J Clin Med. 2025 Jun 5;14(11):4004. doi: 10.3390/jcm14114004.
: This study evaluates intratumoral susceptibility signals (ITSS) as imaging markers for glioma grade prediction and their association with molecular and histopathologic features, in the context of the fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5). : We retrospectively analyzed patients with adult diffuse gliomas who underwent pretreatment magnetic resonance imaging. ITSS were semiquantitatively graded by two radiologists: grade 0 (no signal), grade 1 (1-5), grade 2 (6-10), and grade 3 (≥11). Relative cerebral blood volume (rCBV) and tumor volume were also obtained. Histopathologic features included tumor grade, Ki-67, mitotic count, necrosis, microvascular proliferation, and molecular alterations (isocitrate dehydrogenase [IDH], 1p/19q, cyclin-dependent kinase inhibitors 2A and 2B [CDKN2A/B], and p53). Regression models predicted tumor grade (low: 1-2, high: 3-4) using ITSS, tumor volume, and rCBV. ROC curves and diagnostic performance metrics were analyzed. : 99 patients were included. ITSS grading correlated with rCBV, tumor volume, mitotic count, Ki-67, and tumor grade ( < 0.001). ITSS grades 0-1 were associated with oligodendrogliomas and astrocytomas ( < 0.001), IDH mutations ( < 0.001), and 1p/19q co-deletions ( = 0.01). ITSS grades 2-3 were linked to glioblastomas ( < 0.001), necrosis ( < 0.001), microvascular proliferation ( < 0.001), and CDKN2A/B homozygous deletions ( = 0.02). Models combining ITSS with rCBV and volume showed AUC of 0.94 and 0.96 ( < 0.001), outperforming univariate models. : Semiquantitative ITSS grading correlates with key histopathologic and molecular glioma features. Combined with perfusion and volumetric parameters, ITSS enhance non-invasive glioma grading, in alignment with WHO CNS5.
本研究在《世界卫生组织中枢神经系统肿瘤分类》（WHO CNS5）第五版的背景下，评估瘤内敏感性信号（ITSS）作为胶质瘤分级预测的影像学标志物及其与分子和组织病理学特征的关联。我们回顾性分析了接受预处理磁共振成像的成年弥漫性胶质瘤患者。ITSS由两名放射科医生进行半定量分级：0级（无信号）、1级（1 - 5）、2级（6 - 10）和3级（≥11）。还获取了相对脑血容量（rCBV）和肿瘤体积。组织病理学特征包括肿瘤分级、Ki-67、有丝分裂计数、坏死、微血管增殖以及分子改变（异柠檬酸脱氢酶[IDH]、1p/19q、细胞周期蛋白依赖性激酶抑制剂2A和2B[CDKN2A/B]以及p53）。回归模型使用ITSS、肿瘤体积和rCBV预测肿瘤分级（低级别：1 - 2级，高级别：3 - 4级）。分析了ROC曲线和诊断性能指标。纳入99例患者。ITSS分级与rCBV、肿瘤体积、有丝分裂计数、Ki-67和肿瘤分级相关（<0.001）。ITSS 0 - 1级与少突胶质细胞瘤和星形细胞瘤相关（<0.001）、IDH突变（<0.001）以及1p/19q共缺失（=0.01）。ITSS 2 - 3级与胶质母细胞瘤相关（<0.001）、坏死（<0.001）、微血管增殖（<0.001）以及CDKN2A/B纯合缺失（=0.02）。将ITSS与rCBV和体积相结合的模型显示AUC为0.94和0.96（<0.001），优于单变量模型。半定量ITSS分级与关键的组织病理学和分子胶质瘤特征相关。与灌注和体积参数相结合，ITSS可增强非侵入性胶质瘤分级，与WHO CNS5一致。
