本文選題：體素內(nèi)不相干運動成像 + 異檸檬酸鹽脫氫酶基因��； 參考：《上海醫(yī)學》2017年09期

【摘要】：目的探討體素內(nèi)不相干運動成像(IVIM)無創(chuàng)性診斷彌漫性膠質(zhì)細胞瘤異檸檬酸鹽脫氫酶1(IDH1)基因狀態(tài)的價值。方法前瞻性收集95例彌漫性膠質(zhì)細胞瘤患者的臨床資料,測量腫瘤實性區(qū)域IVIM的各影像學參數(shù):灌注比例系數(shù)(F)、平均表觀擴散系數(shù)(ADCmean)、快速表觀擴散系數(shù)(fastADC)、擴散系數(shù)(DDC)、偽擴散系數(shù)(D*)。計算以對側(cè)腦白質(zhì)區(qū)標化后的參數(shù):相對灌注比例系數(shù)(nrF)、相對平均表觀擴散系數(shù)(nrADCmean)、相對快速表觀擴散系數(shù)(nrfastADC)、相對擴散系數(shù)(nrDDC)、相對偽擴散系數(shù)(nrD*)。隨訪所有入組患者的病理學診斷和IDH1基因檢查結(jié)果。采用獨立樣本t檢驗統(tǒng)計分析同級別IDH1基因野生型與突變型各參數(shù)差異,有效參數(shù)繪制ROC曲線,同時應用Logistics回歸分析計算IDH1基因整體正確預測率。結(jié)果突變型低級別組的F值、ADCmean值、nrADCmean值、DDC值均顯著高于野生型低級別組(P值均0.05),兩組間nrF值、D*值、nrD*值、nrDDC值、fastADC值、nrfastADC值的差異均無統(tǒng)計學意義(P值均0.05)。突變型高級別組的F值、fastADC值均顯著低于野生型高級別組(P值均0.05),兩組間nrF值、ADCmean值、nrADCmean值、D*值、nrD*值、DDC值、nrDDC值、nrfastADC值的差異均無統(tǒng)計學意義(P值均0.05)。低級別膠質(zhì)細胞瘤患者F的切值、敏感度、特異度、ROC曲線的AUC分別為0.125、0.667、0.625、0.780,ADCmean值分別為1.182、0.750、0.875、0.842,nrADCmean值分別為1.481、0.762、0.875、0.899,DDC值分別為1.193、0.792、0.750、0.774。高級別膠質(zhì)細胞瘤患者F的切值、敏感度、特異度、ROC曲線的AUC分別為0.155、0.750、0.750、0.775,fastADC值分別為1.545、0.708、0.875、0.813。低級別膠質(zhì)細胞瘤聯(lián)合F值和nrADCmean值得出診斷IDH1基因的整體正確預測率為93.8%,似然比為13.97。高級別膠質(zhì)細胞瘤聯(lián)合F值和fastADC值得出診斷IDH1基因的整體正確預測率為82.5%,似然比為46.07。結(jié)論 IVIM檢查為術前無創(chuàng)性診斷彌漫膠質(zhì)細胞瘤IDH1基因狀態(tài)提供了新的方法。
[Abstract]:Objective to investigate the value of voxel incoherent motion imaging (IVIMI) in noninvasive diagnosis of isocitrate dehydrogenase (IDH1) gene status in diffuse glioma. Methods the clinical data of 95 patients with diffuse glioma were collected prospectively. The imaging parameters of IVIM in solid tumor region were measured as follows: perfusion ratio coefficient, mean apparent diffusion coefficient, fast apparent diffusion coefficient and pseudo-diffusion coefficient. The normalized parameters of the contralateral white matter area were calculated as follows: relative perfusion ratio coefficient nrFU, relative average apparent diffusion coefficient nrADCmean, relative fast apparent diffusion coefficient nrfast ADCC, relative diffusion coefficient nrDDCI, relative pseudo-diffusion coefficient nrDCU. All patients were followed up with pathological diagnosis and IDH1 gene examination. The differences between the wild type and mutation type of IDH1 gene of the same class were statistically analyzed by t-test of independent samples. The effective parameters were plotted to draw the ROC curve, and the overall correct prediction rate of IDH1 gene was calculated by Logistics regression analysis. Results the F value and the mean value of nrADCmean of mutation type low grade group were significantly higher than those of wild type low grade group (P < 0.05). There was no significant difference between the two groups in nrF value and nrDDC value and fast ADC value and nrfast ADC value (P < 0.05). The F value and fast ADC value of mutant high grade group were significantly lower than that of wild type high grade group (P < 0.05). There was no significant difference between two groups in terms of nrF value and nrDDC value, nrDDC value and nrDDC value respectively (P < 0.05). The AUC values of F, sensitivity and specificity in patients with low grade glioma were 0.125U 0.667U 0.6250.0.780 ADCmean, respectively 1.182nrA0.8750.8750.8750.899DDC was 1.193nrA0.792nrADCmean was 0.7740.0.792nrADCmean was 1.481nrA0.8750.899DDC was 1.193nrA0.792nrADCmean of 0.792nrA0.774, respectively. The AUC values of F, sensitivity, specificity and ROC curves of patients with high grade glioma were 0.155, 0.750, 0.750 and 0.775A, respectively. The values of fast ADC were 1.545U 0.708U 0.875n 0.813, respectively. The overall correct prediction rate of low grade glioma combined with F value and nrADCmean is 93. 8% and the likelihood ratio is 13. 97%. High grade glioma combined with F value and fastADC is worthy of diagnosing IDH1 gene. The overall correct prediction rate is 82.5 and the likelihood ratio is 46.07. Conclusion IVIM provides a new method for noninvasive preoperative diagnosis of IDH1 gene status in diffuse glioma.
【作者單位】： 復旦大學附屬華山醫(yī)院放射科復旦大學醫(yī)學功能與分子影像研究所;復旦大學附屬腫瘤醫(yī)院放射科;復旦大學附屬華山醫(yī)院病理科;
【基金】：國家自然科學基金(81471627)、國家自然科學基金青年項目(81660285)資助 上海市科學技術委員會合作項目(16410722800)
【分類號】：R445.2;R739.41

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