目标:目前,在临床情况下,仍然缺乏已建立的术前测试来准确预测异柠檬酸脱氢酶(IDH)突变状态,有限的研究已经探索了代谢物之间潜在的协同诊断性能,灌注,和扩散参数。为了解决这个问题,我们的目的是开发一种成像方案,整合2-羟基戊二酸(2HG)磁共振波谱(MRS)和体素不相干运动(IVIM)通过全面评估代谢,细胞,和由IDH突变引起的血管生成变化,并探讨了这种成像方案在临床情景中预测IDH突变状态的诊断效率。
方法:将符合纳入标准的患者分为两组:IDH-野生型(IDH-WT)组和IDH-突变型(IDH-MT)组。随后,我们量化了2HG浓度,相对表观扩散系数(rADC),相对真实扩散系数值(rD),相对伪扩散系数(rD*)和相对灌注分数值(rf)。使用t检验和Mann-WhitneyU检验估计组间差异。最后,我们进行了受试者工作特征(ROC)曲线和DeLong检验,以评估和比较各个参数及其组合的诊断性能。
结果:64例患者(女性,21;男性,43岁,47.0±13.7年)。与IDH-WT胶质瘤相比,IDH-MT胶质瘤有较高的2HG浓度,rADC和rD(P<0.001),和较低的rD*(P=0.013)。ROC曲线显示2HG+rD+rD*表现出用于区分IDH突变状态的最高曲线下面积(AUC)值(0.967,95CI0.889-0.996)。与每个单独的参数相比,2HG+rADC+rD*和2HG+rD+rD*的预测效率显示有统计学意义的提高(DeLong检验:P<0.05)。
结论:2HGMRS和IVIM的整合显著提高了临床情景中预测IDH突变状态的诊断效率。
OBJECTIVE: Currently, there remains a scarcity of established preoperative tests to accurately predict the isocitrate dehydrogenase (IDH) mutation status in clinical scenarios, with limited research has explored the potential synergistic diagnostic performance among metabolite, perfusion, and diffusion parameters. To address this issue, we aimed to develop an imaging protocol that integrated 2-hydroxyglutarate (2HG) magnetic resonance spectroscopy (MRS) and intravoxel incoherent motion (IVIM) by comprehensively assessing metabolic, cellular, and angiogenic changes caused by IDH mutations, and explored the diagnostic efficiency of this imaging protocol for predicting IDH mutation status in clinical scenarios.
METHODS: Patients who met the inclusion criteria were categorized into two groups: IDH-wild type (IDH-WT) group and IDH-mutant (IDH-MT) group. Subsequently, we quantified the 2HG concentration, the relative apparent diffusion coefficient (rADC), the relative true diffusion coefficient value (rD), the relative pseudo-diffusion coefficient (rD*) and the relative perfusion fraction value (rf). Intergroup differences were estimated using t-test and Mann-Whitney U test. Finally, we performed receiver operating characteristic (ROC) curve and DeLong\'s test to evaluate and compare the diagnostic performance of individual parameters and their combinations.
RESULTS: 64 patients (female, 21; male, 43; age, 47.0 ± 13.7 years) were enrolled. Compared with IDH-WT gliomas, IDH-MT gliomas had higher 2HG concentration, rADC and rD (P < 0.001), and lower rD* (P = 0.013). The ROC curve demonstrated that 2HG + rD + rD* exhibited the highest areas under curve (AUC) value (0.967, 95%CI 0.889-0.996) for discriminating IDH mutation status. Compared with each individual parameter, the predictive efficiency of 2HG + rADC + rD* and 2HG + rD + rD* shows a statistically significant enhancement (DeLong\'s test: P < 0.05).
CONCLUSIONS: The integration of 2HG MRS and IVIM significantly improves the diagnostic efficiency for predicting IDH mutation status in clinical scenarios.