Background

According to 2021 World Health Organization criteria, adult-type diffuse gliomas include glioblastoma, isocitrate dehydrogenase (IDH)–wildtype; oligodendroglioma, IDH-mutant and 1p/19q-codeleted; and astrocytoma, IDH-mutant, even when contrast enhancement is lacking.

Purpose

To develop and validate simple scoring systems for predicting IDH and subsequent 1p/19q codeletion status in gliomas without contrast enhancement using standard clinical MRI sequences.

Materials and Methods

This retrospective study included adult-type diffuse gliomas lacking contrast at contrast-enhanced MRI from two tertiary referral hospitals between January 2012 and April 2022 with diagnoses confirmed at pathology. IDH status was predicted primarily by using T2–fluid-attenuated inversion recovery (FLAIR) mismatch sign, followed by 1p/19q codeletion prediction. A visual rating of MRI features, apparent diffusion coefficient (ADC) ratio, and relative cerebral blood volume was measured. Scoring systems were developed through univariable and multivariable logistic regressions and underwent calibration and discrimination, including internal and external validation.

Results

For the internal validation cohort, 237 patients were included (mean age, 44.4 years ± 14.4 [SD]; 136 male patients; 193 patients in IDH prediction and 163 patients in 1p/19q prediction). For the external validation cohort, 35 patients were included (46.1 years ± 15.3; 20 male patients; 28 patients in IDH prediction and 24 patients in 1p/19q prediction). The T2-FLAIR mismatch sign demonstrated 100% specificity and 100% positive predictive value for IDH mutation. IDH status prediction scoring system for tumors without mismatch sign included age, ADC ratio, and morphologic characteristics, whereas 1p/19q codeletion prediction for IDH-mutant gliomas included ADC ratio, cortical involvement, and mismatch sign. For IDH status and 1p/19q codeletion prediction, bootstrap-corrected areas under the receiver operating characteristic curve were 0.86 (95% CI: 0.81, 0.90) and 0.73 (95% CI: 0.65, 0.81), respectively, whereas at external validation they were 0.99 (95% CI: 0.98, 1.0) and 0.88 (95% CI: 0.63, 1.0).

Conclusion

The T2-FLAIR mismatch sign and scoring systems using standard clinical MRI predicted IDH and 1p/19q codeletion status in gliomas lacking contrast enhancement.

© RSNA, 2024

Supplemental material is available for this article.

See also the editorial by Badve and Hodges in this issue.

中文翻译：

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用于预测缺乏对比度增强的成人型弥漫性胶质瘤中异柠檬酸脱氢酶突变和染色体 1p/19q 联合缺失的 MRI 评分系统

背景

根据2021年世界卫生组织标准，成人型弥漫性胶质瘤包括胶质母细胞瘤、异柠檬酸脱氢酶（IDH）-野生型；少突胶质细胞瘤，IDH 突变和 1p/19q 共缺失；星形细胞瘤，IDH 突变，即使缺乏对比增强。

目的

开发和验证简单的评分系统，用于使用标准临床 MRI 序列预测 IDH 和随后的胶质瘤中的 1p/19q 联合缺失状态，而无需对比增强。

材料和方法

这项回顾性研究包括 2012 年 1 月至 2022 年 4 月期间在两家三级转诊医院进行的对比增强 MRI 缺乏对比的成人型弥漫性胶质瘤，并经病理学确诊。 IDH 状态主要通过使用 T2 流体衰减反转恢复 (FLAIR) 错配符号进行预测，然后进行 1p/19q 代码删除预测。测量 MRI 特征的视觉评级、表观扩散系数 (ADC) 比率和相对脑血容量。评分系统是通过单变量和多变量逻辑回归开发的，并经过校准和区分，包括内部和外部验证。

结果

对于内部验证队列，纳入了 237 名患者（平均年龄，44.4 岁 ± 14.4 [SD]；136 名男性患者；IDH 预测中的 193 名患者和 1p/19q 预测中的 163 名患者）。对于外部验证队列，纳入了 35 名患者（46.1 岁 ± 15.3 岁；20 名男性患者；28 名患者进行 IDH 预测，24 名患者进行 1p/19q 预测）。 T2-FLAIR 错配标志显示 IDH 突变具有 100% 特异性和 100% 阳性预测值。无错配征象的肿瘤的 IDH 状态预测评分系统包括年龄、ADC 比率和形态学特征，而 IDH 突变胶质瘤的 1p/19q 联合缺失预测包括 ADC 比率、皮质受累和错配征象。对于 IDH 状态和 1p/19q 代码删除预测，受试者工作特征曲线下的自举校正面积分别为 0.86 (95% CI: 0.81, 0.90) 和 0.73 (95% CI: 0.65, 0.81)，而在外部验证时，它们分别为 0.99（95% CI：0.98，1.0）和 0.88（95% CI：0.63，1.0）。

结论

T2-FLAIR 错配标志和评分系统使用标准临床 MRI 预测缺乏对比增强的神经胶质瘤中的 IDH 和 1p/19q 共缺失状态。

© 北美放射学会，2024

本文提供了补充材料。

另请参阅本期 Badve 和 Hodges 的社论。