Abstract：
OBJECTIVE: Accurate preoperative radiological staging of adult-type diffuse glioma is crucial for effective prognostic stratification and selection of appropriate therapeutic interventions. The purpose of this study was to compare the effectiveness of apparent diffusion coefficient (ADC) maps generated from ultrahigh b-value diffusion-weighted imaging (DWI) for molecular grading with that for histological grading of adult-type diffuse glioma, and to evaluate the correlation between these ADC maps and molecular and histological biomarkers.
METHODS: This study retrospectively enrolled forty adult-type diffuse glioma patients, diagnosed using the 2021 WHO classification criteria. Preoperative imaging data, including multiple b-value DWI and conventional magnetic resonance imaging, were collected. Tumors were graded using both histological and molecular criteria. Histogram analysis was conducted to generate 14 parameters for each tumor. Receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate tumor grading and molecular status differentiation. Analysis of histological biomarkers was performed by calculating the Pearson and Spearman correlation coefficients of continuous and hierarchical variables, respectively.
RESULTS: The intensity-related parameters for molecular grading were found to be superior to those for histological grading for the identification of WHO grade 4 (WHO4) adult-type diffuse glioma. The AUC of both grading systems increased with increasing b-values, with ADC8000-based histogram parameters showing the best results (molecular grading, square root: AUC = 0.897; histological grading, median: AUC = 0.737). The intensity-related parameters could also differentiate molecular WHO4 gliomas from histologically lower-grade gliomas (ADC8000-based square root: AUC = 0.919), and different ADC8000-based kurtosis was observed between molecular and histological WHO4 gliomas (AUC = 0.833). Significant correlations between the Ki-67 index and molecular status prediction for IDH, CDKN2A, and EGFR were also demonstrated.
CONCLUSIONS: The histogram parameters derived from high b-value ADC maps were found to be more effective for differentiating molecular grades of WHO4 adult-type diffuse glioma than for differentiating histological grades.
METHODS: This study retrospectively enrolled forty adult-type diffuse glioma patients, diagnosed using the 2021 WHO classification criteria. Preoperative imaging data, including multiple b-value DWI and conventional magnetic resonance imaging, were collected. Tumors were graded using both histological and molecular criteria. Histogram analysis was conducted to generate 14 parameters for each tumor. Receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate tumor grading and molecular status differentiation. Analysis of histological biomarkers was performed by calculating the Pearson and Spearman correlation coefficients of continuous and hierarchical variables, respectively.
RESULTS: The intensity-related parameters for molecular grading were found to be superior to those for histological grading for the identification of WHO grade 4 (WHO4) adult-type diffuse glioma. The AUC of both grading systems increased with increasing b-values, with ADC8000-based histogram parameters showing the best results (molecular grading, square root: AUC = 0.897; histological grading, median: AUC = 0.737). The intensity-related parameters could also differentiate molecular WHO4 gliomas from histologically lower-grade gliomas (ADC8000-based square root: AUC = 0.919), and different ADC8000-based kurtosis was observed between molecular and histological WHO4 gliomas (AUC = 0.833). Significant correlations between the Ki-67 index and molecular status prediction for IDH, CDKN2A, and EGFR were also demonstrated.
CONCLUSIONS: The histogram parameters derived from high b-value ADC maps were found to be more effective for differentiating molecular grades of WHO4 adult-type diffuse glioma than for differentiating histological grades.
摘要：
目的：准确的成人弥漫性神经胶质瘤术前影像学分期对于有效的预后分层和选择适当的治疗干预措施至关重要。这项研究的目的是比较从超高b值扩散加权成像（DWI）生成的表观扩散系数（ADC）图对分子分级的有效性和对成人型弥漫性神经胶质瘤的组织学分级的有效性。并评估这些ADC图与分子和组织学生物标志物之间的相关性。
方法：本研究回顾性纳入了40例成人型弥漫性神经胶质瘤患者，使用2021年WHO分类标准诊断。术前影像数据,包括多b值DWI和常规磁共振成像，被收集。使用组织学和分子标准对肿瘤进行分级。进行直方图分析以产生每个肿瘤的14个参数。受试者工作特征曲线和曲线下面积（AUC）用于评估肿瘤分级和分子状态分化。通过计算连续变量和分层变量的Pearson和Spearman相关系数来分析组织学生物标志物，分别。
结果：对于WHO4级（WHO4）成人型弥漫性神经胶质瘤的鉴定，分子分级的强度相关参数优于组织学分级。两种分级系统的AUC随着b值的增加而增加，基于ADC8000的直方图参数显示最佳结果(分子分级，平方根：AUC=0.897；组织学分级，中位数：AUC=0.737）。强度相关参数还可以区分分子WHO4胶质瘤与组织学上较低级别的胶质瘤（基于ADC8000的平方根：AUC=0.919），在分子和组织学WHO4胶质瘤之间观察到基于ADC8000的峰度不同（AUC=0.833）。Ki-67指数与IDH的分子状态预测之间存在显著相关性，CDKN2A,和EGFR也被证明。
结论：发现从高b值ADC图得出的直方图参数对于区分WHO4成人型弥漫性神经胶质瘤的分子等级比区分组织学等级更有效。
方法：本研究回顾性纳入了40例成人型弥漫性神经胶质瘤患者，使用2021年WHO分类标准诊断。术前影像数据,包括多b值DWI和常规磁共振成像，被收集。使用组织学和分子标准对肿瘤进行分级。进行直方图分析以产生每个肿瘤的14个参数。受试者工作特征曲线和曲线下面积（AUC）用于评估肿瘤分级和分子状态分化。通过计算连续变量和分层变量的Pearson和Spearman相关系数来分析组织学生物标志物，分别。
结果：对于WHO4级（WHO4）成人型弥漫性神经胶质瘤的鉴定，分子分级的强度相关参数优于组织学分级。两种分级系统的AUC随着b值的增加而增加，基于ADC8000的直方图参数显示最佳结果(分子分级，平方根：AUC=0.897；组织学分级，中位数：AUC=0.737）。强度相关参数还可以区分分子WHO4胶质瘤与组织学上较低级别的胶质瘤（基于ADC8000的平方根：AUC=0.919），在分子和组织学WHO4胶质瘤之间观察到基于ADC8000的峰度不同（AUC=0.833）。Ki-67指数与IDH的分子状态预测之间存在显著相关性，CDKN2A,和EGFR也被证明。
结论：发现从高b值ADC图得出的直方图参数对于区分WHO4成人型弥漫性神经胶质瘤的分子等级比区分组织学等级更有效。
