Background: Low-grade gliomas (LGG) in adults are usually slow growing and frequently asymptomatic brain tumors, originating from glial cells of the central nervous system (CNS). Although regarded formally as "benign" neoplasms, they harbor the potential of malignant transformation associated with high morbidity and mortality. Their complex and unpredictable tumor biology requires a reliable and conclusive presurgical magnetic resonance imaging (MRI). A promising and emerging MRI approach in this context is histogram based apparent diffusion coefficient (ADC) profiling, which recently proofed to be capable of providing prognostic relevant information in different tumor entities. Therefore, our study investigated whether histogram profiling of ADC distinguishes grade I from grade II glioma, reflects the proliferation index Ki-67, as well as the IDH (isocitrate dehydrogenase) mutation and MGMT (methylguanine-DNA methyl-transferase) promotor methylation status. Material and Methods: Pre-treatment ADC volumes of 26 LGG patients were used for histogram-profiling. WHO-grade, Ki-67 expression, IDH mutation, and MGMT promotor methylation status were evaluated. Comparative and correlative statistics investigating the association between histogram-profiling and neuropathology were performed. Results: Almost the entire ADC profile (p25, p75, p90, mean, median) was significantly lower in grade II vs. grade I gliomas. Entropy, as second order histogram parameter of ADC volumes, was significantly higher in grade II gliomas compared with grade I gliomas. Mean, maximum value (ADCmax) and the percentiles p10, p75, and p90 of ADC histogram were significantly correlated with Ki-67 expression. Furthermore, minimum ADC value (ADCmin) was significantly associated with MGMT promotor methylation status as well as ADC entropy with IDH-1 mutation status. Conclusions: ADC histogram-profiling is a valuable radiomic approach, which helps differentiating tumor grade, estimating growth kinetics and probably prognostic relevant genetic as well as epigenetic alterations in LGG.

译文

背景:成人中的低度神经胶质瘤(LGG)通常生长缓慢,并且通常是无症状的脑肿瘤,起源于中枢神经系统(CNS)的神经胶质细胞。尽管在形式上被视为“良性”肿瘤,但它们具有与高发病率和高死亡率相关的恶性转化的潜力。它们复杂且不可预测的肿瘤生物学要求可靠且结论性的术前磁共振成像(MRI)。在这种情况下,一种有前途和新兴的MRI方法是基于直方图的表观扩散系数(ADC)分析,最近被证明能够在不同肿瘤实体中提供预后相关信息。因此,我们的研究调查了ADC的直方图谱是否区分I级和II级神经胶质瘤,反映了增殖指数Ki-67以及IDH(异柠檬酸脱氢酶)突变和MGMT(甲基鸟嘌呤-DNA甲基转移酶)启动子甲基化状态。材料和方法:将26例LGG患者的治疗前ADC体积用于直方图分析。评估了WHO级,Ki-67表达,IDH突变和MGMT启动子甲基化状态。进行了比较和相关统计调查直方图分析和神经病理学之间的关联。结果:与I级神经胶质瘤相比,II级神经胶质瘤的几乎所有ADC谱(p25,p75,p90,平均值,中位数)均显着降低。作为ADC体积的二阶直方图参数,熵在II级神经胶质瘤中明显高于I级神经胶质瘤。 ADC直方图的平均值,最大值(ADCmax)和百分位数p10,p75和p90与Ki-67表达显着相关。此外,最小ADC值(ADCmin)与MGMT启动子甲基化状态以及IDH-1突变状态的ADC熵显着相关。结论:ADC直方图分析是一种有价值的放射学方法,可帮助区分肿瘤分级,估计生长动力学以及可能预后LGG的相关遗传以及后生遗传学改变。

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