DWI与^(1)H-MRS预测胶质瘤基因分型的价值

The Value of DWI and^(1)H-MRS in Predicting Glioma Genotyping

目的探讨DWI及氢质子磁共振波谱(^(1)H-MRS)术前预测胶质瘤基因分型的价值。方法回顾性分析59例胶质瘤患者临床、病理及影像资料。根据病理结果将胶质瘤分为三型:异柠檬酸脱氢酶(IDH)野生型、IDH突变1p/19q联合缺失型、IDH突变1p/19q未缺失型。每例患者均接受DWI及MRS检查。比较IDH野生型胶质瘤与突变型胶质瘤之间影像学参数[ADC、N-乙酰天门冬氨酸(NAA)、肌酸(Cr)及胆碱(Cho)],绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUC)、灵敏度、特异度。多组间影像参数比较采用Kruskal-Wallis检验,事后两两比较结果采用Bonferroni校正。结果IDH野生组ADC最大值(ADC_(max))、ADC最小值(ADC_(min))、ADC平均值(ADC_(ave))和相对肌酸(rCr)值低于突变组(P<0.05),Cho/Cr值高于突变组(P<0.05)。ADC_(ave)的诊断效能最高,AUC为0.853,取最佳阈值1.049×10^(-3)mm^(2)/s时,敏感度为92.00%,特异度为76.47%。多组间比较,IDH野生型胶质瘤ADC_(max)、ADC_(min)、ADC_(ave)、rCr及Cho/Cr值与IDH突变1p/19q联合缺失型有统计学差异(P<0.05),1p/19q联合缺失型胶质瘤与1p/19q未缺失型相比,各影像学参数无统计学意义(P>0.05)。结论DWI及MRS对于术前预测胶质瘤IDH突变有一定的临床价值,可为胶质瘤患者个体化治疗及预后评估提供一定帮助。

Objective To investigate the value of diffusion weighted imaging(DWI)and single voxel proton spectroscopy(^(1)H-MRS)in predicting glioma genotyping.Methods The clinical,pathological and imaging data of the patients with glioma in our hospital were analyzed retrospectively.According to the pathological results,gliomas were divided into three types:IDH wild type,IDH mutation with 1p/19q codeletion and IDH mutation with 1p/19q non-codeletion.All patients underwent DWI and MRS.The imaging parameters[Apparent diffusion coefficient(ADC),N-acetylaspartate(NAA),creatine(Cr)and choline(Cho)]between IDH wild-type glioma and IDH mutant glioma were compared,the receiver operating characteristic curves(ROC)were drawn,and the area under curve(AUC),sensitivity and specificity were calculated.The Kruskal-Wallis test was used for multi-group comparisons,and Bonferroni correction was used for post pairwise comparison results.Results The maximum ADC value(ADC_(max)),minimum ADC value(ADC_(min)),average ADC value(ADC_(ave)),and relative creatine(rCr)value of IDH wild group were significantly lower than those in mutation group(P<0.05),and the value of Cho/Cr was significantly higher than that in mutation group(P<0.05).ADC_(ave)provided the highest diagnostic efficiency with the AUC of 0.853.The best threshold was 1.049×10^(-3)mm^(2)/s with a sensitivity of 92.00%,a specificity of 76.47%,respectively.There were significant differences in ADC_(max),ADC_(min),ADC_(ave),rCr and Cho/Cr between IDH wild-type gliomas and IDH mutations with 1p/19q codeletion group(P<0.05),while there were no significant differences in other imaging parameters between 1p/19q codeletion gliomas and 1p/19q non-codeletion(P>0.05).Conclusion DWI and MRS have the potential to provide clinical value for preoperative prediction of IDH mutation in glioma,which can benefit individualized treatment and prognosis evaluation for glioma patients.