Ultra-high-field sodium MRI as biomarker for tumor extent, grade and IDH mutation status in glioma patients.
Ultra-high-field sodium MRI as biomarker for tumor extent, grade and IDH mutation status in glioma patients.
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DOI：
10.1016/j.nicl.2020.102427
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Paech D
中科院分区：
文献类型：
--
作者：
Regnery S;Behl NGR;Platt T;Weinfurtner N;Windisch P;Deike-Hofmann K;Sahm F;Bendszus M;Debus J;Ladd ME;Schlemmer HP;Rieken S;Adeberg S;Paech D
MRI导出的总23 Na浓度在胶质瘤亚区中显著不同。总23 Na浓度可反映IDH突变状态和肿瘤分级。23 Na MRI产生用于治疗胶质瘤的潜在非侵入性生物标志物。这项前瞻性临床试验研究了7特斯拉（T）场强下的钠（23 Na）MRI作为胶质瘤患者肿瘤范围、异柠檬酸脱氢酶（IDH）突变和O 6-甲基鸟嘌呤DNA甲基转移酶（MGMT）启动子甲基化的生物标志物。28例胶质瘤患者在放化疗前在7 T扫描仪（Siemens Healthcare，埃尔兰根，德国）上接受了与标准3 T MRI平行的23 Na MRI。在3 T MRI成像上分割钆对比增强（gdce）、非增强T2高信号（视为水肿）、坏死和外观正常的白色物质（nawm）区域，并与23 Na图像配准。通过成对t检验比较所有区域的中位总23 Na浓度。此外，gdce和水肿区域合并，以产生整个肿瘤区域而无坏死。随后，使用Whitney-Mann U检验比较IDH突变型和IDH野生型胶质瘤以及MGMT甲基化和MGMT非甲基化胶质母细胞瘤之间的整个肿瘤区域的23 Na浓度中位数差异。在Bonferroni-Holm程序后校正所有p值。23 Na浓度从新生到坏死区依次升高（平均值±标准差：nawm = 37.84 ± 5.87 mM，水肿= 54.69 ± 10.64 mM，gdce = 61.72 ± 12.95 mM，坏死= 81.88 ± 17.53 mM），所有相关区域之间的浓度差异具有统计学显著性（所有成对比较的调整p值< 0.05）。此外，IDH突变的神经胶质瘤显示出比IDH野生型神经胶质瘤显著更高的23 Na浓度（中值[四分位距]：IDH野生型= 52.37 mM [45.98 - 58.56 mM]，IDH突变型= 65.02 mM [58.87-67.05 mM]，p = 0.039）。在胶质母细胞瘤中，MGMT甲基化肿瘤中的23 Na浓度有增加的趋势，但未达到统计学显著性（中位数[四分位数间距]：MGMT甲基化= 57.59 mM [50.70 - 59.17 mM]，MGMT未甲基化= 48.78 mM [45.88 - 53.91 mM]，p = 1.0）。23 Na MRI与IDH突变状态相关，因此可以增强对活检部位的图像引导，如图像引导手术和放疗的威尔斯。此外，23 Na浓度从中央坏死到正常外观的白色物质的连续降低表明与肿瘤浸润相关。
MRI derived total 23Na concentration differs significantly in glioma subregions. Total 23Na concentration could reflect IDH mutation status and tumor grade. 23Na MRI yields potential non-invasive biomarkers for the treatment of gliomas. This prospective clinical trial investigated sodium (23Na) MRI at 7 Tesla (T) field strength as biomarker for tumor extent, isocitrate dehydrogenase (IDH) mutation and O6-methylguanine DNA methyltransferase (MGMT) promotor methylation in glioma patients. 28 glioma patients underwent 23Na MRI on a 7T scanner (Siemens Healthcare, Erlangen, Germany) parallel to standard 3T MRI before chemoradiation. Areas of Gadolinium-contrast enhancement (gdce), non-enhancing T2-hyperintensity (regarded as edema), necrosis, and normal-appearing white matter (nawm) were segmented on 3T MRI imaging and were co-registered with the 23Na images. The median total 23Na concentrations of all areas were compared by pairwise t-tests. Furthermore, areas of gdce and edema were merged to yield the whole tumor area without necrosis. Subsequently, the difference in median of the 23Na concentration of this whole tumor area was compared between IDH-mutated and IDH wild-type gliomas as well as MGMT methylated and MGMT not-methylated glioblastomas using Whitney-Mann U-tests. All p-values were corrected after the Bonferroni-Holm procedure. The 23Na concentration increased successively from nawm to necrotic areas (mean ± sd: nawm = 37.84 ± 5.87 mM, edema = 54.69 ± 10.64 mM, gdce = 61.72 ± 12.95 mM, necrosis = 81.88 ± 17.53 mM) and the concentrations differed statistically significantly between all regarded areas (adjusted p-values for all pairwise comparisons < 0.05). Furthermore, IDH-mutated gliomas showed significantly higher 23Na concentrations than IDH wild-type gliomas (median [interquartile range]: IDH wild-type = 52.37 mM [45.98 – 58.56 mM], IDH mutated = 65.02 mM [58.87–67.05 mM], p = 0.039). Among the glioblastomas, there was a trend towards increased 23Na concentration in MGMT methylated tumors that did not reach statistical significance (median [interquartile range]: MGMT methylated = 57.59 mM [50.70 – 59.17 mM], MGMT not methylated = 48.78 mM [45.88 – 53.91 mM], p = 1.0). 23Na MRI correlates with the IDH mutation status and could therefore enhance image guidance towards biopsy sites as wells as image-guided surgery and radiotherapy. Furthermore, the successive decrease of 23Na concentration from central necrosis to normal-appearing white matter suggests a correlation with tumor infiltration.
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DOI：
10.7759/cureus.2502
发表时间：
2018-04-18
期刊：
Cureus
影响因子：
--
作者：
Huang L;Zhang Z;Qu B;Cui Z;Wang Y;Li J;Wang J;Zuo Z;Zhuo Y;Yu X;Lin Z;Pan L
通讯作者：
Pan L
影响因子：
12.7
作者：
Olar A;Wani KM;Alfaro-Munoz KD;Heathcock LE;van Thuijl HF;Gilbert MR;Armstrong TS;Sulman EP;Cahill DP;Vera-Bolanos E;Yuan Y;Reijneveld JC;Ylstra B;Wesseling P;Aldape KD
通讯作者：
Aldape KD
影响因子：
2.8
作者：
Haneder, Stefan;Giordano, Frank A.;Ong, Melissa M.
通讯作者：
Ong, Melissa M.
在增强胶质母细胞瘤的增强和非增强部分的肿瘤浸润：与组织病理学的相关性。
影响因子：
3.7
作者：
Eidel O;Burth S;Neumann JO;Kieslich PJ;Sahm F;Jungk C;Kickingereder P;Bickelhaupt S;Mundiyanapurath S;Bäumer P;Wick W;Schlemmer HP;Kiening K;Unterberg A;Bendszus M;Radbruch A
通讯作者：
Radbruch A
影响因子：
158.5
作者：
Hegi, ME;Diserens, A;Stupp, R
通讯作者：
Stupp, R