动脉自旋标记衍生的脑血流量全域直方图预测弥漫性中线胶质瘤H3K27M突变状态的价值

Value of Arterial Spin Labeling-Derived Cerebral Blood Flow Map of Whole-Domain Histogram in Predicting H3K27M Mutation in Patient with Diffuse Midline Gliomas

目的 探讨动脉自旋标记衍生的脑血流量(CBF)全域直方图预测弥漫性中线胶质瘤H3K27M突变状态的价值。资料与方法 回顾性分析2016年1月—2021年3月重庆大学附属三峡医院、成都中医药大学附属医院、重庆医科大学附属第一医院经穿刺活检或手术病理证实的54例弥漫性中线胶质瘤(H3K27M突变型26例,H3K27M野生型28例)患者的资料。应用MaZda软件于轴位CBF图像上沿肿瘤边界勾画感兴趣区,并进行CBF直方图分析,分析CBF参数:中位数、第10百分位、偏度、极差、方差、不均一性、最大值、最小值、四分位间距、众数、峰度、熵值,比较两组上述参数的差异,对有差异统计学意义的变量进行二元Logistic回归分析;绘制受试者工作特征曲线对上述各参数预测弥漫性中线胶质瘤H3K27M突变状态效能进行比较。结果 H3K27M突变型组中位数、第10百分位、偏度和极差均高于H3K27M野生型组,方差和不均一性低于H3K27M野生型组(Z/t=-1.54、2.81、2.23、1.47、-2.32、2.57),差异均有统计学意义(P<0.05)。第10百分位的曲线下面积为0.769,以18.43为截断值,敏感度、特异度及准确度分别为79.9%、76.7%、89.7%。联合多个直方图参数分析的曲线下面积、敏感度、特异度及准确度分别是0.813、81.4%、79.3%、91.7%。结论 动脉自旋标记衍生的CBF全域直方图可以预测弥漫性中线胶质瘤H3K27M突变状态,单个参数中第10百分位的诊断效能最高。联合多个直方图参数能够进一步提高预测效能。

Purpose To demonstrate the value of arterial spin labeling(ASL) derived cerebral blood flow(CBF) of whole-domain histogram in predicting the H3K27M mutation in patient with diffuse midline glioma patients. Materials and Methods A total of 54patients diagnosed as brain diffuse midline gliomas confirmed by biopsy or surgical pathology in Chongqing University Three Gorges Hospital, Hospital of Chengdu University of Traditional Chinese Medicine, and the First Affiliated Hospital of Chongqing Medical University from January 2016 to March 2021(including 26 patients with H3K27M mutant and 28 patients with H3K27M wild-type) were retrospectively enrolled. MaZda software was applied to draw the region of interest along the tumor boundary at all tumor levels on the axial CBF image, and CBF histogram analysis was performed to analyze CBF parameters as follows: median, 10th percentile, skewness,range, variance, heterogeneity, maximum, minimum, interquartile range, mode, kurtosis and entropy. The differences of the above parameters were compared between the two groups. The binary logistic regression was performed to analyze the variables with statistical differences between the two groups. The receiver operating characteristic curve was drawn to predict H3K27M mutation status in patient with diffuse midline gliomas and the efficacy of all these parameters were further compared. Results The median, 10th percentile,skewness and range of H3K27M mutant group were significantly higher than those of H3K27M wild-type group, while the variance and heterogeneity were significantly lower than those of H3K27M wild-type group(Z/t=-1.54, 2.81, 2.23, 1.47,-2.32 and 2.57 respectively,all P<0.05). The area under the curve of the 10th percentile was 0.769. Taking 18.43 as the cut-off value, the sensitivity, specificity and accuracy was 79.9%, 76.7% and 89.7% respectively. The area under the curve, sensitivity, specificity and accuracy of combining multiple histogram parameters was 0.813, 81.4%, 79.3% and 91.7%, respectively. Conclusion The whole domain histogram of ASL-derived CBF can predict the mutation of H3K27M in patient with diffuse midline gliomas, among which the 10th percentile has the highest diagnostic efficiency. Combining multiple histogram parameters can further improve the prediction efficiency.