幕上IDH突变型低级别胶质瘤MRI特征与病理相关研究

Relationship between MR imaging features and pathologic changes in human supratentorial low grade gliomas with IDH mutation

目的分析对比幕上异柠檬酸脱氢酶(IDH)突变型及野生型低级别胶质瘤的影像学特征,并与病理相关指标进行统计及相关性分析。方法手术及病理证实82例低级别胶质瘤(WHOⅡ级),其中IDH突变型39例,IDH1野生型43例,术前行核磁共振影像(MRI)增强扫描61例,按照无强化、轻度强化、中度强化、重度强化分别进行统计,并与增殖细胞核抗原Ki-67(Ki-67)标记指数、钙黏蛋白(CD34)CD34及1号染色体短臂/19号染色体长臂(1p/19q)杂合性联合缺失(co-deleiton)情况进行统计及相关性分析。结果 IDH突变低级别胶质瘤好发于右侧额叶,其次为右侧颞叶和左侧颞叶,IDH野生型低级别胶质瘤好发于左侧额叶,其次为左侧颞叶和右侧颞叶,经Fisher's Exact Test检验,二者间有统计学差异(P<0.05)。肿瘤IDH是否突变导致的肿瘤强化程度、Ki-67、CD34及1p/19q联合缺失差异均无统计学意义(P>0.05)。肿瘤强化程度与Ki-67指标呈正相关性(Spearman秩相关分析),与CD34和1p/19q联合缺失,无统计学意义的相关性。结论 IDH1突变低级别胶质瘤具有显著的好发部位,以右侧额叶为主,右侧颞叶其次,低级别胶质瘤无论IDH是否突变其常规增强MRI表现无明显差异。

Objective The imaging features and related pathological indicators between the Isocitrate dehydrogenase（ IDH） mutation group and wild-type group in human superatentorial low grade gliomas are investigated.Methods A total of 82 cases of gliomas（ WHO gradeⅡ） confirmed by surgery were involved,including39 cases of IDH mutation and 43 cases of IDH wild type.Sixty-one cases of them were performed contrast enhanced MRI before operation.Degrees of tumors＇ enhancement including none,slight,medium and severe enhancement were recorded respectively and its relationship with pathological indicators such as proliferating cell nuclear antigen Ki-67（ Ki-67）,cadherin CD34（ CD34） and 1p/19 q co-deletion by SPSS 19.0 software was analyzed.Results Low grade gliomas with IDH mutation likely occurred in right frontal lobe and then right and left temporal lobe,while IDH wild type group likely occurred in left frontal lobe and then left and right temporal lobe.There was significant difference between two groups by Fisher＇s Exact Test（ P〈0.05）.There were no significant differences in enhancement degree,Ki-67,CD34 and the short arm of chromosome 1 / the long arm of chromosome 19（ 1p /19q） co-deletion between IDH mutation group and IDH wild type group（ P〉0.05）.There was positive correlation between degree of enhancement and Ki-67 index（ rs =0.288,P =0.020,Spearman rank correlation analysis）.There were no significant differences between enhancement degree and CD34 or 1p /19 q co-deletion.Conclusion Low grade glioma with IDH mutation have marked tendency to occur in right frontal lobe and then temporal lobe.There is no significant difference in enhancement degree between IDH mutation group and IDH wild type group in low grade gliomas.