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Prediction of Ki-67 labeling index, ATRX mutation, and MGMT promoter methylation status in IDH-mutant astrocytoma by morphological MRI, SWI, DWI, and DSC-PWI

  • Magnetic Resonance
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Abstract

Objective

Noninvasive detection of molecular status of astrocytoma is of great clinical significance for predicting therapeutic response and prognosis. We aimed to evaluate whether morphological MRI (mMRI), SWI, DWI, and DSC-PWI could predict Ki-67 labeling index (LI), ATRX mutation, and MGMT promoter methylation status in IDH mutant (IDH-mut) astrocytoma.

Methods

We retrospectively analyzed mMRI, SWI, DWI, and DSC-PWI in 136 patients with IDH-mut astrocytoma.The features of mMRI and intratumoral susceptibility signals (ITSS) were compared using Fisher exact test or chi-square tests. Wilcoxon rank sum test was used to compare the minimum ADC (ADCmin), and minimum relative ADC (rADCmin) of IDH-mut astrocytoma in different molecular markers status. Mann–Whitney U test was used to compare the rCBVmax of IDH-mut astrocytoma with different molecular markers status. Receiver operating characteristic curves was performed to evaluate their diagnostic performances.

Results

ITSS, ADCmin, rADCmin, and rCBVmax were significantly different between high and low Ki-67 LI groups. ITSS, ADCmin, and rADCmin were significantly different between ATRX mutant and wild-type groups. Necrosis, edema, enhancement, and margin pattern were significantly different between low and high Ki-67 LI groups. Peritumoral edema was significantly different between ATRX mutant and wild-type groups. Grade 3 IDH-mut astrocytoma with unmethylated MGMT promoter was more likely to show enhancement compared to the methylated group.

Conclusions

mMRI, SWI, DWI, and DSC-PWI were shown to have the potential to predict Ki-67 LI and ATRX mutation status in IDH-mut astrocytoma. A combination of mMRI and SWI may improve diagnostic performance for predicting Ki-67 LI and ATRX mutation status.

Clinical relevance statement

Conventional MRI and functional MRI (SWI, DWI, and DSC-PWI) can predict Ki-67 expression and ATRX mutation status of IDH mutant astrocytoma, which may help clinicians determine personalized treatment plans and predict patient outcomes.

Key Points

• A combination of multimodal MRI may improve the diagnostic performance to predict Ki-67 LI and ATRX mutation status.

• Compared with IDH-mutant astrocytoma with low Ki-67 LI, IDH-mutant astrocytoma with high Ki-67 LI was more likely to show necrosis, edema, enhancement, poorly defined margin, higher ITSS levels, lower ADC, and higher rCBV.

• ATRX wild-type IDH-mutant astrocytoma was more likely to show edema, higher ITSS levels, and lower ADC compared to ATRX mutant IDH-mutant astrocytoma.

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Abbreviations

ADC:

Apparent diffusion coefficient

ADCmin :

Minimum apparent diffusion coefficient

AIC:

Akaike information criterion

ATRX:

X-linked alpha-thalassemia/mental retardation syndrome

AUC:

Area under the curve

CBV:

Cerebral blood volume

CNS:

Central nervous system

DSC-PWI:

Dynamic susceptibility contrast perfusion-weighted imaging

DWI:

Diffusion-weighted imaging

FLAIR:

Fluid-attenuated inversion recovery imaging

FOV:

Field of view

Gd-BOPTA:

Gadobenate dimeglumine

IDH:

Isocitrate dehydrogenase

ITSS:

Intratumoral susceptibility signal intensity

LI:

Labeling index

MGMT:

Oxygen-6-methylguanine-DNA-methyltransferase

MIP:

Minimum intensity projection

mMRI:

Morphological magnetic resonance imaging

rADCmin :

Minimum relative apparent diffusion coefficient

rCBVmax :

Relative maximum cerebral blood volume

ROC:

Receiver operating characteristic

ROI:

Regions of interest

Sen:

Sensitivity

Spe:

Specificity

SWI:

Susceptibility-weighted imaging

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

VIF:

Variance inflation factor

WHO:

World Health Organization

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Acknowledgements

We thank Zebin Xiao for his advice on manuscript writing.

Funding

This work was funded by the National Natural Science Foundation of China (No. 82071869); the Leading Project of the Department of Science and Technology of Fujian Province (no. 2020Y0025); Fujian Provincial Health Technology Project (no. 2021QNB006); and Joint Funds for the Innovation of Science and Technology, Fujian Province (no. 2021Y9154).

Author information

Author notes

  1. Xiefeng Yang and Chengcong Hu are co-first authors and contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People’s Republic of China

    Xiefeng Yang, Zhen Xing, Yu Lin, Yan Su & Dairong Cao

  2. Department of Pathology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, 20 Cha-Zhong Road, Fuzhou, 350005, People’s Republic of China

    Chengcong Hu & Xingfu Wang

  3. Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China

    Dairong Cao

  4. Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China

    Dairong Cao

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  1. Xiefeng Yang
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Correspondence to Xingfu Wang or Dairong Cao.

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Guarantor

The scientific guarantor of this publication is Dairong Cao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some patients in the present study cohort overlapped with one of our studies which is now published online (https://doi.org/10.1186/s12880-022-00832-3), in which we used diffusion, susceptibility, and perfusion-weighted imaging to grade IDH mutant astrocytoma. As for the advanced MRI part, 107 cases (78.6%) overlapped in these two studies. In the present study, we used conventional MRI, SWI, DWI, and DSC-PWI to predict Ki-67 Labeling Index, ATRX Mutation, and MGMT Promoter Methylation Status, which is far different from our previous study.

Methodology

  • retrospective

  • diagnostic or prognostic study

  • performed at one institution

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Yang, X., Hu, C., Xing, Z. et al. Prediction of Ki-67 labeling index, ATRX mutation, and MGMT promoter methylation status in IDH-mutant astrocytoma by morphological MRI, SWI, DWI, and DSC-PWI. Eur Radiol 33, 7003–7014 (2023). https://doi.org/10.1007/s00330-023-09695-w

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