摘要
目的:研究原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)MRI图像参数与分子病理的关联性.方法:回顾性分析 2020年 1月至 2023年 6月就诊于哈尔滨医科大学附属第一医院 26例PCNSL患者资料,根据细胞来源、BCL-2表达、Ki-67指数,MAP+布鲁顿酪氨酸激酶抑制剂(Bruton's tyrosine kinase inhibitor,BTKi)治疗反应性将患者归纳至非生发中心B细胞(non-germinal center B-cell,non-GCB)组和生发中心B细胞(germinal center B-cell,GCB)组、Ki-67≥75%组和Ki-67<75%组、BCL-2+组和BCL-2-组、对MAP+BTKi方案治疗有反应组和无反应组.提取患者基线期MRI图像一阶参数如平均值、标准差、方差、变异系数、偏度、峰度、熵,比较其在两组间的差异.结果:方差、峰度、偏度、变异系数等 4个参数在组间差异无统计学意义;平均数、标准差、熵这 3个参数在Ki-67表达、BCL-2表达组间的差异具有统计学意义;平均数、熵这两个参数在细胞来源、治疗是否有反应性两组间差异具有统计学意义(P<0.05);对于Ki-67指数,3个参数的曲线下面积(AUC)分别为0.731、0.831、0.913;对于BCL-2表达,平均数、标准差的曲线下面积(AUC)分别为 0.889和 0.938.多参数联合分析时其鉴识效果较利用单个纹理分析定量参数更高.结论:平均值、标准差、熵等 3个MRI参数有助于预测PCNSL患者Ki-67、BCL-2的表达,对于治疗具有一定评估作用,有利于术前无创性评估肿瘤的恶性程度并为预后和治疗提供新的依据.
Abstract
Objective:To investigated the relationship between magnetic resonance imaging(MRI)parameters and the molecular pathology of primary central nervous system lymphoma(PCNSL).Methods:We retrospectively analyzed 26 patients from The First Affiliated Hospital of Harbin Medical University between January 2020 and June 2023 classified into germinal center B-cell like(GCB)and non-germinal center B-cell like(non-GCB)groups based on cell origin,into Ki-67≥75%and<75%groups based on the Ki-67 index,into BCL-2+and BCL-2-groups based on BCL-2 expression,and into responsive and non-responsive groups based on their response to MAP+Bruton's tyrosine kinase inhib-itor(BTKi)treatment.We extracted and compared first-order parameters between the groups,including mean value,standard deviation,variance,coefficient of variation,skewness,kurtosis,and entropy from baseline MRI images.Results:Four parameters(variance,kurtosis,skewness,and coefficient of variation)showed no significant differences between groups.However,three parameters(mean,standard devi-ation,and entropy)significantly differed between the groups based on Ki-67 and BCL-2 expression.For the Ki-67 index,the three parameters'areas under the curve(AUC)were 0.731,0.831,and 0.913,respectively.For BCL-2 expression,the mean and standard deviation AUCs were 0.889 and 0.938,respectively.In addition,the mean and entropy parameters significantly differed between the groups categorized by cell origin and treatment responsiveness(P<0.05).Multi-parameter joint analysis demonstrated greater identification accuracy compared to util-izing individual quantitative parameters from texture analysis.Conclusions:The mean,standard deviation,and entropy MRI parameters can help predict Ki-67 and BCL-2 expression in patients with PCNSL and have evaluative functions for treatment.They are beneficial for preoper-ative non-invasive assessment of tumor malignancy,providing vidence for prognosis and treatment planning.
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