Angiogenesis And Degree Of Differentiation In Molecular Pathologic Classification Of Glioma By Dynamic Contrast-enhanced Magnetic Resonance And Incoherent Motion Diffusion-weighted Imaging

Objective: To compare and evaluate the value of DCE-MRI pharmacokinetic parameters on preoperative grade and staging of glioma,and to explore the correlation between quantitative analysis parameters of DCE-MRI and angiogenesis and differentiation degree of glioma.Methods and materials: According to the inclusion and exclusion criteria,the included patients underwent routine MRI sequence scan and DCEMRI examination respectively,and the surgical findings and pathological findings were compared and analyzed.The volume transfer constant(Ktrans),extravascular extracellular space(EES)volume fraction(VE)and rate constant(KEP)were calculated by two-compartment model analysis.Parameters of each group were measured at the maximum tumor display level.According to the 2016 WHO classification and grading standards of the central nervous system tumors,glioma of this research can be divided into: WHO Ⅰ,Ⅱ level for low grade glioma(LGG)group and the WHO Ⅲ Ⅳ level for high grade glioma(HGG).According to the results of immunohistochemical examination,the lowgrade glioma group and high-grade glioma group were divided into IDH1 gene mutant subgroup and IDH1 gene wild type subgroup.CD34 was used as the marker to calculate the microvessel density of glioma.Mann-Whitney U rank sum test was used to compare MVD between gliomas of different grades.Spearman rank correlation was used to analyze the correlation between DCE-MRI parameters and pathological grade and microvessel density.Mann-Whitney U rank sum test was used to evaluate the differences of each parameter value between the high-grade group and the low-grade group.All statistics are based on0.05 indicates that the difference is statistically significant.Receieper operating characteristic(ROC)method was used to analyze and compare the parameters obtained to evaluate the efficacy of glioma pathological grading group and microvessel density grade.Results: From July 2015 to February 2021,104 patients with glioma were confirmed by surgery and pathology.There were 55 males and 49 females,aged from 22 to 78 years,with an average of(52.8±12.5)years.There were 57 cases of low-grade glioma,47 cases of high-grade glioma,52 cases of IDH1 gene mutation and 52 cases of IDH1 gene wild type.In CD34 immunohistochemical samples,the microvessel density ranged from 5.2 to 38.4.MVD of HGG group was significantly higher than that of LGG group.There were statistically significant differences in Ktrans,Ve and Kep values among glioma patients with different pathological grades(P<0.05).Spearman correlation analysis showed that Ktrans value,VE value and KEP value were positively correlated with glioma microvascular density(MVD)(R value was 0.835,0.593 and 0.593,P < 0.01).Ktrans value had the best correlation(r=0.835,P < 0.01).ROC analysis showed that the evaluation efficiency of DCE-MR pharmacokinetic parameters on glioma microvascular density from high to low was Ktrans > Ve> Kep.There were statistically significant differences in Ktrans and Ve values between the mutant and wild-type advanced gliomas(P<0.05),the Ktrans and Ve values of mutant were lower than those of wild type.Conclusions: DCE-MRI can provide more comprehensive information for the diagnosis of glioma,and can be used as an effective auxiliary means for preoperative grading and staging of glioma,and can predict the mutant and wild type of IDH1 gene in glioma.Quantitative DCE-MRI can provide pathophysiological information on angiogenesis,perfusion and vascular permeability in glioma tissues,and has important clinical value in the evaluation of angiogenesis and differentiation degree of glioma tumors.Objective: The value of IVIIM-DWI parameters in preoperative grading and staging of glioma was compared and evaluated,and the correlation between IVIIM-DWI quantitative analysis parameters and angiogenesis and differentiation degree of glioma was discussed.To compare the differences and efficacy of IVIMDWI and DCE-MRI in evaluating angiogenesis and differentiation degree of glioma.Methods and materials: According to the inclusion and exclusion criteria,MRI routine examination and 8 B-value DWI(0-1000s/mm2)examination were performed in the included patients.Parameter values such as slow diffusion coefficient of motion(D),rapid diffusion coefficient of motion(D*)and microcirculatory perfusion fraction(F)were calculated by double exponential fitting.Parameters of each group were measured at the maximum tumor display level.According to the 2016 WHO classification and grading standards of the central nervous system tumors,glioma of this research can be divided into: WHOⅠ,Ⅱ level for low grade glioma(LGG)group and the WHO Ⅲ Ⅳ level for high grade glioma(HGG).CD34 was used as a marker to calculate the microvessel density of HCC.Spearman rank correlation was used to analyze the correlation between IVIM-DWI parameters and DCE-MRI parameters,and to evaluate the correlation between the parameters of the two imaging techniques and the pathological grade and microvessel density of glioma.According to the mean value,the microvascular density(MVD)was divided into two groups,and receiver operating characteristic(ROC)method was used to analyze and compare the evaluation efficacy of different parameters in the evaluation of glioma MVD grade and pathological grading group.Results: Low grade gliomas,a total of 57 cases of high grade glioma,a total of 47 cases,IDH1 gene mutation type and IDH1 gene of wild type all 52 cases.In CD34 immunohistochemical samples,the microvessel density ranged from 5.2 to38.4.Ivim parameter D values,D* values and f values are positively correlated with microvessel density(MVD),with f values being significantly positively correlated with D* values(r=0.765 and 0.751,P<0.001).The parameters D* and f associated with IVIM-DWI perfusion are positively correlated with the DCE-MRI parameters Ktrans and Ve.D*,f and Ktrans are well correlated with each other(r=0.690,0.649,PLT;0.001),D*,f and Ve were moderately correlated(r=0.529,0.522,P<0.001).ROC curves intuitively showed that IVIM-DWI and DCE parameters had good sensitivity and specificity in the evaluation of the degree of glioma differentiation.Ktrans>D*>f>Ve was the most effective to the least effective in the evaluation.Conclusions: There is correlation between parameters obtained from IVIMDWI and pharmacokinetic model DCE-MRI.DCE-MRI parameter Ktrans value is superior to IVIM-DWI in the evaluation of glioma microvascular density and vascular permeability,while IVIM-DWI D* value and F value are superior to DCE-MRI in the evaluation of capillary proportion.Combined use of the two values can provide a more comprehensive and accurate evaluation of angiogenesis and differentiation degree of glioma with different molecular pathological types.For patients at risk of using contrast agents,IVIM-DWI can be used alone to objectively and accurately evaluate the degree of angiogenesis and differentiation of glioma.