Gry Hanna S, Falk Delgado Anna
Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, 17176, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Clin Neuroradiol. 2025 Aug 20. doi: 10.1007/s00062-025-01550-3.
Molecular glioblastomas are challenging to distinguish from lower-grade diffuse astrocytomas (grades 2-3) without T2/T2 FLAIR mismatch, when assessed on T1-gadolinium and T2/T2 FLAIR MRI. This study aimed to evaluate the performance of the ADC from diffusion-weighted imaging and the relative CBV from DSC perfusion imaging in differentiating molecular glioblastomas from lower-grade diffuse astrocytomas.
Fourteen patients with molecular glioblastomas (defined as isocitrate dehydrogenase wildtype (IDH-wt), exhibiting one or more of the following: telomerase reverse transcriptase (TERT) promoter mutation, epidermal growth factor receptor (EGFR) gene amplification, or +7/-10 chromosomal alterations, but without microvascular proliferation or necrosis) and thirteen patients with lower-grade diffuse astrocytomas (IDH-mutated or not elsewhere classified, grades 2-3) were included. ADC values and DSC-rCBV values were measured, and the two groups were compared using T‑test and Wilcoxon rank-sum test. Combinations of variables and tumor characteristics were analyzed using binary logistic regression, receiver operating curve (ROC) analysis, and Firth regression model.
Molecular glioblastomas exhibited lower minimum ADC, mean ADC (p < 0.01), maximum ADC (p < 0.05) and higher standard deviation of ADC (p < 0.05), compared to lower-grade astrocytomas, measured in a 7 mm ROI in the lowest ADC region. Molecular glioblastoma also had higher normalized median, average, and minimum rCBV ratios (p < 0.01) in a 10 mm ROI in the highest perfused region. A combined receiver operating curve (ROC) model of ADC and rCBV achieved an area under the curve (AUC) of 0.93 (95% CI: 0.82-1.00).
This study demonstrates that ADC and rCBV measurements can help differentiate molecular glioblastomas from lower-grade diffuse astrocytomas lacking T2/T2 FLAIR mismatch. These findings may aid in preoperative tumor characterization, surgical planning, and prognosis.
在通过T1加权增强磁共振成像（T1-gadolinium）和T2加权/液体衰减反转恢复序列（T2/T2 FLAIR）磁共振成像进行评估时，若不存在T2/T2 FLAIR不匹配，分子型胶质母细胞瘤很难与低级别弥漫性星形细胞瘤（2-3级）区分开来。本研究旨在评估扩散加权成像中的表观扩散系数（ADC）以及动态对比增强灌注成像中的相对脑血容量（rCBV）在鉴别分子型胶质母细胞瘤与低级别弥漫性星形细胞瘤方面的性能。
纳入14例分子型胶质母细胞瘤患者（定义为异柠檬酸脱氢酶野生型（IDH-wt），具有以下一种或多种特征：端粒酶逆转录酶（TERT）启动子突变、表皮生长因子受体（EGFR）基因扩增或+7/-10染色体改变，但无微血管增殖或坏死）以及13例低级别弥漫性星形细胞瘤患者（IDH突变或其他未分类，2-3级）。测量ADC值和DSC-rCBV值，并使用t检验和Wilcoxon秩和检验对两组进行比较。使用二元逻辑回归、受试者工作特征曲线（ROC）分析和Firth回归模型分析变量与肿瘤特征的组合。
在最低ADC区域的7mm感兴趣区内测量发现，与低级别星形细胞瘤相比，分子型胶质母细胞瘤的最小ADC、平均ADC（p<0.01）、最大ADC（p<0.05）较低，ADC的标准差较高（p<0.05）。在灌注最高区域的10mm感兴趣区内，分子型胶质母细胞瘤的标准化中位数、平均rCBV比值和最小rCBV比值也较高（p<0.01）。ADC和rCBV的联合受试者工作特征曲线（ROC）模型的曲线下面积（AUC）为0.93（95%CI：0.82-1.00）。
本研究表明，ADC和rCBV测量有助于鉴别缺乏T2/T2 FLAIR不匹配的分子型胶质母细胞瘤与低级别弥漫性星形细胞瘤。这些发现可能有助于术前肿瘤特征描述、手术规划和预后评估。
