We aimed to differentiate the isocitrate dehydrogenase (IDH) status among non-enhanced astrocytic tumors using preoperative MRI and PET. We analyzed 82 patients with non-contrast-enhanced, diffuse, supratentorial astrocytic tumors (IDH mutant [IDH-mut], 55 patients; IDH-wildtype [IDH-wt], 27 patients) who underwent MRI and PET between May 2012 and December 2022. We calculated the fractional anisotropy (FA) and mean diffusivity (MD) values using diffusion tensor imaging. We evaluated the tumor/normal brain uptake (T/N) ratios using11C-methionine,11C-choline, and18F-fluorodeoxyglucose PET; extracted the parameters with significant differences in distinguishing the IDH status; and verified their diagnostic accuracy. Patients with astrocytomas were significantly younger than those with glioblastomas. The following MRI findings were significant predictors of IDH-wt instead of IDH-mut: thalamus invasion, contralateral cerebral hemisphere invasion, location adjacent to the ventricular walls, higher FA value, and lower MD value. The T/N ratio for all tracers was significantly higher for IDH-wt than for IDH-mut. In a composite diagnosis based on nine parameters, including age, 84.4% of cases with 0–4 points were of IDH-mut; conversely, 100% of cases with 6–9 points were of IDH-wt. Composite diagnosis using all parameters, including MRI and PET findings with significant differences, may help guide treatment decisions for early-stage gliomas.
本研究旨在利用术前磁共振成像（MRI）与正电子发射断层扫描（PET）技术，对非强化性星形细胞瘤的异柠檬酸脱氢酶（IDH）状态进行鉴别。我们分析了2012年5月至2022年12月期间接受MRI和PET检查的82例非强化、弥漫性、幕上星形细胞瘤患者（其中IDH突变型55例，IDH野生型27例）。通过弥散张量成像计算了各向异性分数（FA）和平均弥散率（MD）值，并利用¹¹C-蛋氨酸、¹¹C-胆碱及¹⁸F-氟代脱氧葡萄糖PET评估了肿瘤/正常脑组织摄取比值。研究提取了在区分IDH状态方面具有显著差异的参数，并验证了其诊断准确性。 结果显示，星形细胞瘤患者年龄显著低于胶质母细胞瘤患者。以下MRI特征可作为IDH野生型（而非IDH突变型）的显著预测指标：丘脑侵犯、对侧大脑半球侵犯、脑室壁邻近部位、较高的FA值及较低的MD值。所有示踪剂的肿瘤/正常脑组织摄取比值在IDH野生型中均显著高于IDH突变型。在包含年龄等9项参数的复合诊断模型中，0-4分病例中84.4%为IDH突变型，而6-9分病例100%为IDH野生型。综合运用包括MRI与PET显著差异参数在内的所有指标进行复合诊断，可为早期胶质瘤的治疗决策提供指导。
肿瘤(癌症)患者之家