Zhao Shanshan, Wang Peipei, Gao Eryuan, Wang Mengzhu, Yang Guang, Niu Shouhui, Pan Mengjiao, Zhao Kai, Cheng Jingliang, Ma Xiaoyue
Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
MR Research Collaboration, Siemens Healthineers Ltd., Beijing, China.
Front Oncol. 2025 Jul 30;15:1551023. doi: 10.3389/fonc.2025.1551023. eCollection 2025.
BACKGROUND AND PURPOSE: In the 2021 WHO Classification, the importance of molecular pathology in glioma diagnosis has been emphasized, particularly the status of isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deletion. Advanced magnetic resonance diffusion-weighted imaging (DWI) including mono-exponential (Mono), intravoxel incoherent motion (IVIM), stretched exponential model (SEM) techniques are beneficial for non-invasive prediction of these molecular markers. The continuous-time random walk (CTRW) model mitigates the empirical nature of the SEM and has shown promising results in grading gliomas. However, the application of CTRW model in prediction of IDH and 1p/19q molecular phenotypes in adult diffuse gliomas remains underreported. This study compares the clinical utility of mono-exponential, IVIM, SEM, and CTRW models for predicting IDH and 1p/19q molecular status in adult diffuse gliomas. MATERIALS AND METHODS: Data of adult diffuse glioma patients from January 2021 to August 2023 were collected. The multi-b-value DWI was acquired using a spin-echo echo-planar imaging sequence with 13 b-values (0, 10, 20, 30, 50, 70, 100, 150, 200, 400, 800, 1500, 2000 s/mm²) in 30 diffusion-encoding directions. Multi-b-value DWI images were post-processed to generate parametric maps based on the mono-exponential (Mono), the intravoxel incoherent motion (IVIM), the stretched exponential model (SEM) and the continuous-time random walk (CTRW) models. The mean parameter values of solid tumor regions were calculated. An independent sample -test or Mann-Whitney test was used for comparisons between different subtypes of glioma. Receiver operating characteristic (ROC) analyses were used to assess diagnostic performance. RESULTS: A total of 95 glioma patients were included in the study. For predicting IDH status, CTRW_α exhibited the largest effect size and best diagnostic performance with an AUC of 0.761. At a threshold of 0.855, the sensitivity was 0.651, the specificity was 0.846, and the accuracy was 0.758. In predicting 1p/19q status in IDH-mutant gliomas, CTRW_α again showed the largest effect size and the best diagnostic performance with an AUC of 0.790. At a threshold of 0.886, sensitivity was 0.750, specificity was 0.903, and accuracy was 0.860. CONCLUSIONS: The CTRW model could help predict IDH and 1p/19q status in adult diffuse gliomas.
背景与目的：在2021年世界卫生组织分类中，分子病理学在胶质瘤诊断中的重要性得到了强调，尤其是异柠檬酸脱氢酶（IDH）突变和1p/19q共缺失的状态。包括单指数（Mono）、体素内不相干运动（IVIM）、拉伸指数模型（SEM）技术在内的先进磁共振扩散加权成像（DWI）有利于对这些分子标志物进行无创预测。连续时间随机游走（CTRW）模型减轻了SEM的经验性质，并在胶质瘤分级中显示出有前景的结果。然而，CTRW模型在预测成人弥漫性胶质瘤中IDH和1p/19q分子表型方面的应用仍报道较少。本研究比较了单指数、IVIM、SEM和CTRW模型在预测成人弥漫性胶质瘤中IDH和1p/19q分子状态方面的临床效用。 材料与方法：收集2021年1月至2023年8月成人弥漫性胶质瘤患者的数据。使用自旋回波平面成像序列，在30个扩散编码方向上获取具有13个b值（0、10、20、30、50、70、100、150、200、400、800、1500、2000 s/mm²）的多b值DWI。对多b值DWI图像进行后处理，以基于单指数（Mono）、体素内不相干运动（IVIM）、拉伸指数模型（SEM）和连续时间随机游走（CTRW）模型生成参数图。计算实体瘤区域的平均参数值。采用独立样本t检验或曼-惠特尼检验对不同亚型的胶质瘤进行比较。采用受试者操作特征（ROC）分析来评估诊断性能。 结果：本研究共纳入95例胶质瘤患者。对于预测IDH状态，CTRW_α表现出最大的效应量和最佳的诊断性能，AUC为0.761。在阈值为0.855时，灵敏度为0.651，特异性为0.846，准确率为0.758。在预测IDH突变型胶质瘤的1p/19q状态时，CTRW_α再次表现出最大的效应量和最佳的诊断性能，AUC为0.790。在阈值为0.886时，灵敏度为0.750，特异性为0.903，准确率为0.860。 结论：CTRW模型有助于预测成人弥漫性胶质瘤中IDH和1p/19q的状态。
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