Abstract

Purpose

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.

中文翻译：

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2HG MRS 和 IVIM 整合与单个参数在临床情况下预测胶质瘤 IDH 突变状态的诊断效率：一项回顾性研究

摘要

目的

目前，仍然缺乏既定的术前测试来准确预测临床情况下的异柠檬酸脱氢酶（IDH）突变状态，并且探索代谢物、灌注和扩散参数之间潜在的协同诊断性能的研究也很有限。为了解决这个问题，我们的目标是通过综合评估 IDH 突变引起的代谢、细胞和血管生成变化，开发一种集成 2-羟基戊二酸 (2HG) 磁共振波谱 (MRS) 和体素内不相干运动 (IVIM) 的成像方案，并探索该成像方案在临床场景中预测 IDH 突变状态的诊断效率。

方法

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 检验和曼-惠特尼 U 检验估计组间差异。最后，我们进行受试者工作特征（ROC）曲线和德隆检验来评估和比较单个参数及其组合的诊断性能。

结果

64 名患者（女性，21 名；男性，43 名；年龄，47.0 ± 13.7 岁）入组。与 IDH-WT 胶质瘤相比，IDH-MT 胶质瘤的 2HG 浓度、rADC 和 rD 较高（P  < 0.001），而 rD* 较低（P  = 0.013）。ROC 曲线表明，2HG + rD + rD* 在区分 IDH 突变状态方面表现出最高的曲线下面积 (AUC) 值（0.967，95%CI 0.889–0.996）。与各个单独参数相比，2HG + rADC + rD* 和 2HG + rD + rD* 的预测效率显示出统计上显着的增强（DeLong 检验：P  < 0.05）。

结论

2HG MRS 和 IVIM 的集成显着提高了临床场景中预测 IDH 突变状态的诊断效率。