| Objective To investigate the clinical value of three-dimensional pseudo-continuous arterial spin labeling and intravoxel incoherent motion imaging in glioma grading and the correlation with isocitrate dehydrogenase-1.Materials and Methods Clinical data: 26 low grade gliomas patients were collected(30 male cases and 22 female cases),ranging in age from 14 to 65 years old(median age 42 years old),with 16 patients with IDH1 mutant and 10 with wild type.There were 52 high-grade gliomas patients(30 males and 22 females),ranging in age from 13 to 76 years old(median age 55 years old),11 with IDH1 mutant and 41 with wild type were obtained.All patients were confirmed by surgical pathology and had IDH1 immunohistochemical analysis.Imaging data: all patients underwent the conventional MR scan(T1WI,T2 WI,DWI,T2FLAIR),T1 WI enhanced scanning,3D-p CASL and IVIM in GE 3.0T MR before surgery.Post-processing: through the post-processing workstation,ASL cerebral blood flow(CBF)and IVIM true diffusion coefficient D(slow ADC),pseudo-diffusion coefficient D*(fast ADC)and perfusion fraction f(fraction of fast ADC)were obtained.The high perfusion area was selected from the ASL pseudo-color map to draw the area of interest to obtain the tumor parenchymal area and the CBF value of the mirror side,and the relative CBF value was calculated(r CBF,r CBF = CBF value of the tumor side/CBF value of the mirror side).Combined with T1 WI enhanced scan images,the parameters D,D* and f values of the tumor parenchymal region,1cm around the tumor and the mirror side were obtained on the IVIM pseudo-color map.Tumor parenchyma and peritumor areas were delineated with 3 ROIs,avoiding tumor cystic changes,necrotic areas and vascular deformation areas as far as possible.The mean value was taken,and the ROI area was 40~60mm2,and the measurements were repeated twice at 1~2 weeks. Statistical analysis:(1)Chi-square test was performed on the gender and IDH1 status of patients in the HGG and LGG group,and two independent sample t tests were performed on the age of patients in the two groups.Then,Chi-square test was performed on the gender and different grade of glioma in IDH1 wild group and mutation group,and two independent sample t tests were performed on the age of patients in the two groups.(2)ASL parameters(CBFmax,r CBF)and IVIM parameters(Dmin,D*max,fmax)between high and low grade glioma groups were tested by independent sample analysis,and P<0.05 showed statistical difference.Two independent samples t test or non-parametric Mann-Whitney test were used to compare the parameters of the HGG and LGG groups at different locations(tumor parenchyma,1cm around the tumor and normal areas).P<0.05 showed statistical difference.Two independent samples t test or non-parametric Mann-Whitney test were performed on the parameters of tumor parenchyma,tumor circumference 1cm and normal area in the HGG and LGG groups respectively,and there was a statistical difference of P<0.05.Receiver operating characteristic(ROC)was used to further analyze the parameters,and the area under the curve(AUC),sensitivity,specificity and threshold were obtained.(3)ASL parameters(CBFmax,r CBF)and IVIM parameters(Dmin,D*max,fmax)of IDH1 mutant and wild-type glioma were tested by independent sample analysis,and P<0.05 showed statistical difference.Two independent sample t test or non-parametric Mann-Whitney test were performed for each parameter between the IDH1 mutant and the wild-type glioma groups,and there was a statistical difference of P<0.05.Receiver operating characteristic Using the ROC to obtain the area under the curve(AUC),sensitivity,specificity and threshold.Result The age of the HGG group was significantly higher than that of the LGG group(P<0.05),There was no difference in gender distribution between the HGG group and the LGG group(P>0.05),and the IDH1 gene mutation rate of the LGG group was significantly higher than that of the HGG group(P<0.05).The age of IDH1 wild group was significantly higher than that of mutant group(P<0.05),and there was no difference in gender distribution between IDH1 wild group and mutant group(P>0.05).The values of CBFmax and r CBF in the tumor parenchyma area and the peri-tumor 1cm area in the HGG group were significantly higher than those in the LGG group(P<0.05),Dmin value in tumor parenchyma area of the HGG group was significantly lower than that of the LGG group(P<0.05),and there was no statistical difference in the Dmin value in the peri-tumor 1cm area between the two groups(P>0.05).There was no significant difference in D*max and fmax values between the two groups(P>0.05)in either the tumor parenchyma or the region of 1cm around the tumor.In the HGG group,there were significant differences in the tumor parenchymal,1cm around tumor,and the normal area(P<0.05),with the highest CBFmax value in the tumor parenchymal area and the lowest in the normal area.In the LGG group,there were no significant differences in the tumor parenchymal,1cm around tumor,and the normal area of the CBFmax(P>0.05).In the HGG group or LGG group,the Dmin value of tumor parenchyma was significantly higher than that in the normal area and 1cm around tumor(P<0.05).There was no statistical difference between the Dmin value of 1cm around tumor and that of the normal area in the two groups(P>0.05).In the HGG group,the D*max value in the 1cm tumor region was significantly greater than that in the tumor parenchyma and the normal region(P<0.05),and there was no statistical difference between the tumor parenchyma region and the normal region(P>0.05).In the LGG group,the D*max values of the tumor parenchyma area and the perioma 1cm area were significantly higher than the normal area(P<0.05),and there was no significant difference between the tumor parenchyma and the perioma 1cm area(P>0.05).In the HGG and LGG groups,the fmax value in the 1cm region around tumor was significantly higher than that in the normal region(P<0.05),but there was no statistical difference between the tumor parenchyma region and the 1cm region around tumor,the tumor parenchyma region and the normal region(P>0.05).The values of CBFmax and r CBF in the tumor parenchymal area and 1cm around the tumor were significantly higher in the IDH1 wild group than in the IDH1 mutant group(P<0.05),while there was no statistical difference in the values of Dmin,D*max and fmax(P>0.05).ROC curve analysis: the AUC corresponding to CBFmax,r CBF and Dmin in the tumor parenchymal region between the HGG and LGG groups were 0.818(95%CI:0.704~0.933)(threshold 94.63,sensitivity 84.6%,specificity 76.9%),0.861(95%CI: 0.757~0.965)(threshold 1.83,sensitivity 76.9%,specificity 88.5%),and 0.684(95%CI: 0.544~0.824)(threshold 0.76,sensitivity 57.7%,specificity 82.7%),respectively.The AUC of CBFmax and r CBF in the 1cm region around the tumor were 0.774(95%CI: 0.658~0.890)(threshold 49.09,sensitivity 80.8%,specificity 67.3%)and 0.773(95%CI: 0.668~0.878)(threshold 1.01,sensitivity 80.8%,specificity 69.2%).The area under the curve of CBFmax and r CBF in the tumor parenchymal region between IDH1 wild and mutant group was 0.708(95%CI: 0.573~0.843),0.725(95%CI: 0.540~0.798),and the threshold value of CBFmax was 91.28,The corresponding sensitivity and specificity were 74.1% and 74.1%,respectively.When the r CBF parameter threshold is 1.53,the corresponding sensitivity and specificity are 55.6% and 84.3%,respectively.The AUC corresponding to CBFmax and r CBF in the 1cm tumor region were 0.669(95%CI: 0.596~0.853)(threshold 49.09,sensitivity 70.4%,specificity 62.7%)and 0.709(95%CI: 0.589~0.829)(threshold 0.96,sensitivity 63.0%,specificity 74.5%).Conclusion 1.The CBFmax and r CBF values of ASL and Dmin of IVIM at tumor parenchymal and tumor circumference of glioma can effectively distinguish high grade gliomas from low grade,among which the diagnostic efficacy of r CBF at tumor parenchymal is better among these parameters.2.The CBFmax,r CBF of ASL at tumor parenchymal and tumor circumference have certain differential diagnostic significance for IDH1 genotyping,which diagnostic efficacy of r CBF in the tumor parenchymal is better,owing to the instability parameters of IVIM,further study is needed.3.The diffusion and perfusion information of the intratamoral and peritumor region in 3D p CASL and IVIM could be useful to distinguish the grade of glioma preoperative,and the perfusion parameters of ASL are related to IDH1 genotype statue,which could be helpful to estimate the malignant degree of gliomas before operation,to make individualized treatment plan and to evaluate the prognosis in the future. |
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