The main genetic differences of HGG are shown in different MRI and MRS imaging.

High-level glioma (HGG) is a common malignant brain tumor in adults.
study found that molecular markers such as isochlic acid dehydrogenase gene (IDH1), tumor suppression protein p53 (TP53) and thalassemia, mental retardation x chain gene (ATRX) have important guiding significance for HGG's biological behavior, treatment strategies and clinical prognosis.
12% of HGG patients detected IDH1 mutant (IDH-mut), while IDH-mut patients had a longer overall lifetime than IDH1 wild type (IDH-wt).
addition, TP53 mutations were common in HGG patients, and in 57% of secondary HGG, TP53 mutations overlapped with ATRX mutations, but were rarer in primary HGG.
recent studies have attempted to find a correlation between imaging and genetic characteristics that can predict the prognostics and response to treatment in HGG patients from imaging.
because many mutations in HGG affect metabolism, imaging techniques based on in vivo metabolism may help determine prognosm.
such as MRI spectral imaging (MRS) can detect a metabolite of IDH1-mut-HGG, D-2-hydroxyglutarate (D-2-Hydroxyglutarate, D-2-HG).
mr. Ngela Bernabéu-Sanz of the Magnetic Resonance Department of alicante General University Hospital in Spain studied the different MRI and MRS imaging manifestations of the main genetic differences of HGG, the results of which were published online in September 2020 in Radio Europeanlogy.
study included 79 HGG patients who analyzed the expression levels of IDH, ATRX, Ki-67 and p53 through immunogasification, applied MRI to examine tumor imaging performance and MRS to evaluate metabolic and immersion characteristics, and further clarified the relationship between HGG imaging characteristics and molecular science.
the prognostic factors using the Kaplan-Meier method and the Cox regression model.
results of the study showed that of the 79 HGG patients, 56 were glioblastoma (GBM) and 23 were WHO III.class astromas.
14 cases (17.7%) were IDH-mut, with the majority of young patients (p<0.001).
7 cases (8.9%) were ATRX mutants, of which 3 were IDH1-wt and 4 were IDH1-mut.
18 cases (22.8%) were Ki-67>5% of patients, of which 15 were IDH1-wt and 3 were IDH1-mut.
56 cases (70.9%) were p53<50% patients, of which 50 cases of IDH1-wt and 6 cases of IDH1-mut were.
MRI imaging showed that 69 patients (87.34%) had a single lesion, of which 58 (73.4%) had a lesions confined to one-sided brain leaves, most commonly the frontal leaves.
IDH1-mut tumor is larger than IDH1-wt.
the distribution of left and right lesions, IDH1-mut lesions are mostly found in the frontal temporal lobe.
IDH1-wt type edema is more common than IDH1-mut type.
there was no obvious correlation between IDH1 state and tumor immersion mode.
IDH1-mut type, WHO III. lesions are common.
74 patients (93.67%) had an enhanced lesions.
there was no obvious correlation between lesions and IDH1 state.
MRS results showed high levels of fluid lipids in the IDH-wt type (p-0.001).
MRI examination showed that tumors that did not express p53 and Ki-67>5% were highly impregnable (p-0.009 and p-0.008, respectively).
IDH1 status is not significantly different from the nADC value expressed by p53.
gbM, the average and minimum values of nADC are lower than THAT III.grade as astromas (p-0.025 and p-0.017, respectively).
the ATRX-wt type, the ATRX-mut type has a high level of glutamine/creatinine (Glx/Cr), the ATRX-wt type Glx/Cr is 2.16±2.04, and the ATRX-mut Glx/Cr is 4.74±2.04;
addition, the Glx/Cr level is positively related to the immersion mode in MRSI (r=0.57; p=0.02).
MRI and MRS performance in 2 typical patients, as shown in Figures 1 and 2.
1. 1 case of 28-year-old female patient; MRI imaging shows that the lesions are located in the center of the left frontal leaf, the volume is 18.97cm3, the center of the lesions is a cerebrospinal fluid-like signal, T1 weighted image is low signal, T2 weighted and FLAR is like visible outer weekly high signal (arrow).
DWI images are not dispersed and are not reinforced.
b. Tumor NAA decreased significantly, suggesting neuron/axon loss, choline elevation indicates malignant tumor, lactic acid peak appears, cr increase indicates glial origin.
c.MRSI results show that Cho/Cr and Cho/NAA metabolic maps, as well as zoomed-in charts of Cho/CR maps after data analysis.
d. as shown in Cho/Cr and Cho/NAA, MRSI does not show tumor immersion mode.
the MRI image below, NE (yellow) shows the boundaries without enhanced lesions.
. hematopathological diagnosis: interdescing assoblastoma (WHO III.grade), IDH1-wt type, p53 positive and Ki-67<5%.
2. A case of a 55-year-old male; MRI imaging shows that the lesions are located at the lower right forehead, the boundaries are not clear, and the volume is 18.76cm3.
lesions are heterogeneic, T1-weighted images are low-signal, tumor-surrounding edema, T2-weighted and FLAR-like high signals, and DWI images are visible dispersions are limited.
uneven reinforcement (arrow) around the tumor.
b. Tumor NAA was significantly reduced, suggesting neuron/axon loss, choline elevation suggesting malignant tumors, inositol appearing to indicate glial origin, and flow lipids suggesting necrosis.
c.MRSI results show that Cho/Cr and Cho/NAA metabolic maps, as well as zoomed-in charts of Cho/CR maps after data analysis.
d. MRSI shows tumor immersion patterns as shown in Cho/Cr and Cho/NAA diagrams.
image below, CE (blue) is the boundary of the hardened area and NE (yellow) is the non-enhanced region.
e.hematopathology diagnosis: glioblastoma (WHO IV.grade), IDH1 mutation, p53 negative and Ki-67>5%.
the results of the three-year survival analysis suggest that the overall three-year survival rate is 17.72%.
Kaplan-Meier analysis showed that factors associated with overall survival were IDH1 mutation, age (<60 years), histological diagnosis, tumor location (left hemisphere), Cho/Cr (<2.7) and Lip/Cr (<7.23).
, in multi-factor analysis, only IDH1, age, and Cho/Cr levels were identified as independent predictors with better prognosmation.
The results show that necrotasia of IDH1-wt tumors is more common than IDH1-mut, and HGG immersion mode is associated with p53 expression loss, Ki-67 index and Glx level.
addition to the IDH1 state, tumor choline levels can be used as predictors of survival and can more accurately predict the prognostication of HGG patients.
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