MRI surrogates for molecular subgroups of medulloblastoma.
MRI surrogates for molecular subgroups of medulloblastoma.
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DOI：
10.3174/ajnr.a3990
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发表时间：
2014-07
期刊：
影响因子：
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通讯作者：
Yeom KW
中科院分区：
文献类型：
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作者：
Perreault S;Ramaswamy V;Achrol AS;Chao K;Liu TT;Shih D;Remke M;Schubert S;Bouffet E;Fisher PG;Partap S;Vogel H;Taylor MD;Cho YJ;Yeom KW
最近发现的髓母细胞瘤分子亚群显示出改善风险分层的潜力。我们假设不同的磁共振成像特征可以预测这些亚群。所有在同一机构诊断为成神经管细胞瘤的患者，包括治疗前磁共振成像和手术组织，作为发现队列（n = 47）。由3名盲法神经放射学家评估MR成像特征。基于纳米串的肿瘤组织检测将肿瘤分为4个已建立的分子亚群（无翅、超音刺猬、3组和4组）。来自独立机构的第二个儿童髓母细胞瘤队列（n = 52）用于验证预测分子亚型的MR成像特征。发现队列的Logistic回归分析显示肿瘤位置（P < 0.001）和增强模式（P = 0.001）是成神经管细胞瘤亚组的重要预测因素。立体特异性计算分析证实，第3组和第4组肿瘤主要发生在第四脑室中线内（100%,P = 0.007），无翼肿瘤定位于小脑脚/小脑桥脑角池，阳性预测值为100% (95% CI, 30%-100%)，音刺猬肿瘤出现在小脑半球，阳性预测值为100% （95% CI, 59%-100%）。中线第4组肿瘤表现为轻微/无强化，阳性预测值为91% （95% CI, 59%-98%）。当我们使用基于磁共振成像特征的回归模型时，66%的髓母细胞瘤在发现队列中被正确预测，65%在验证队列中被正确预测。肿瘤位置和增强模式可预测儿童髓母细胞瘤的分子亚群，并可能作为基因组检测的替代指标。
Recently identified molecular subgroups of medulloblastoma have shown potential for improved risk stratification. We hypothesized that distinct MR imaging features can predict these subgroups. All patients with a diagnosis of medulloblastoma at one institution, with both pretherapy MR imaging and surgical tissue, served as the discovery cohort (n = 47). MR imaging features were assessed by 3 blinded neuroradiologists. NanoString-based assay of tumor tissues was conducted to classify the tumors into the 4 established molecular subgroups (wingless, sonic hedgehog, group 3, and group 4). A second pediatric medulloblastoma cohort (n = 52) from an independent institution was used for validation of the MR imaging features predictive of the molecular subtypes. Logistic regression analysis within the discovery cohort revealed tumor location (P < .001) and enhancement pattern (P = .001) to be significant predictors of medulloblastoma subgroups. Stereospecific computational analyses confirmed that group 3 and 4 tumors predominated within the midline fourth ventricle (100%, P = .007), wingless tumors were localized to the cerebellar peduncle/cerebellopontine angle cistern with a positive predictive value of 100% (95% CI, 30%–100%), and sonic hedgehog tumors arose in the cerebellar hemispheres with a positive predictive value of 100% (95% CI, 59%–100%). Midline group 4 tumors presented with minimal/no enhancement with a positive predictive value of 91% (95% CI, 59%–98%). When we used the MR imaging feature–based regression model, 66% of medulloblastomas were correctly predicted in the discovery cohort, and 65%, in the validation cohort. Tumor location and enhancement pattern were predictive of molecular subgroups of pediatric medulloblastoma and may potentially serve as a surrogate for genomic testing.