MR酰胺质子转移成像预测脑干胶质瘤病理分级的价值

目的探讨MR酰胺质子转移成像(APTWI)预测脑干胶质瘤(BSG)病理分级的临床应用价值。方法回顾性分析2019年8月至2020年6月在首都医科大学附属北京天坛医院就诊且术前2周同时接受MRI及APTWI并具有病理分级结果的41例BSG患者的资料。41例患者中高级别BSG 20例、低级别BSG 21例,结合常规MR图像,在APTWI图像上获得肿瘤实质区的酰胺质子转移(APT)信号强度(%)。采用χ²检验或独立样本t检验分析高级别与低级别BSG患者的性别分布、年龄、APT信号强度的差异;并绘制受试者操作特征(ROC)曲线,预测APT信号强度鉴别诊断高、低级别BSG效能,并计算约登指数,得出最佳诊断阈值;结合Hosmer-Lemeshow拟合优度检验分析APT信号强度的预测能力。结果高级别与低级别BSG患者年龄分别为(23±18)岁、(20±17)岁,t=0.97,P=0.340]及性别分布(男/女分别为9/11、9/12,χ²=0.02,P=0.890)差异无统计学意义;高级别BSG的APT信号强度(3.9±0.9)%]明显高于低级别BSG(2.8±0.9)%],差异具有统计学意义(t=4.16,P<0.001)。APT信号强度区分高、低级别BSG的曲线下面积为0.836,以2.85%为APT信号强度的最佳诊断阈值,其鉴别诊断高、低级别BSG的灵敏度为90.0%,特异度为71.4%。Hosmer-Lemeshow拟合优度检验显示APTWI对BSG级别具有良好的预测能力(χ²=13.33,P=0.101)。结论APTWI有助于鉴别BSG的高、低级别,对预测BSG的病理分级具有较好的临床应用潜力。

The value of MR amide proton transfer weighted imaging technique in predicting the pathological grade of brainstem glioma

Objective To evaluate the clinical application value of MR amide proton transfer weighted imaging(APTWI)in predicting the pathological grade of brainstem glioma(BSG).Methods The data of 41 BSG patients in Beijing Tiantan Hospital,Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed.According to the pathological results,41 patients were classified into high-grade BSG(20 patients)and low-grade BSG(21 patients).Combined with conventional MR images,the signal intensity(%)of amide proton transfer(APT)in the parenchymal area of the tumor was obtained on APTWI images.χ² test or independent sample t-test was used to analyze the differences in gender distribution,age and APT signal intensity between patients with high and low grade BSG.Receiver operating characteristic(ROC)curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG,and Youden index was calculated to obtain the optimal diagnostic threshold;the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test.Results There was no significant difference in age(23±18)years,(20±17)years,t=0.97,P=0.340]and gender distribution(9/11,9/12 for males/females,χ²=0.02,P=0.890)between high-grade and low-grade BSG patients.The APT signal intensity of high-grade BSG(3.9±0.9)%]was significantly higher than that of low-grade BSG(2.8±0.9)%],and the difference had statistical significance(t=4.16,P<0.001).The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836,and with 2.85%as the optimal diagnostic threshold of APT signal intensity,its sensitivity for the diagnosis of high-grade BSG was 90.0%and specificity was 71.4%.The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade(χ²=13.33,P=0.101).Conclusion APTWI can be applied in distinguishing high grade BSG from low grade BSG,and has clinical value in predicting glioma grading.