在2021年最新的世界卫生组织分类中，即使无组织学证据支持存在坏死或微血管增殖，也可以通过多种分子特征诊断成人四级弥漫性胶质瘤。我们旨在通过探索整个肿瘤直方图中获得的表观弥散系数（ADC）直方图特征，区分组织学高级别的胶质瘤中分子特征四级的存在（Mol-4）和不存在（Mol-2/3）。2019年6月至2022年10月期间，共有184名患有弥漫性胶质瘤的成人接受了MRI检查。在排除了121名患者后，招募了18名（中位年龄64.5岁，范围37-84岁）Mol-4患者和45名（中位年龄40岁，范围18-73岁）Mol-2/3患者，均为组织学低级别的胶质瘤。计算了基于整个肿瘤感兴趣区域（volume-of-interest）的ADC直方图特征，并将两组进行比较。利用ADC直方图特征和诊断年龄的Akaike信息准则进行逐步 logistic 回归分析，选出预测Mol-4组病例的独立变量。与Mol-2/3组相比，规范化ADC的90th百分位数（p < 0.001），中位数（p < 0.001），平均值（p < 0.001），10th百分位数（p = 0.014）和熵值（p < 0.001）更低，而峰度（p < 0.001）和偏度（p = 0.046）更高。多元 logistic 回归分析显示，规范化ADC的熵值和诊断年龄是独立预测Mol-4组的参数，曲线下面积为0.92。ADC直方图特征可能是预测组织学低级别成人弥漫性胶质瘤中分子四级的有希望的术前成像生物标志物。本研究强调了ADC直方图特征在区分组织学低级别成人弥漫性胶质瘤中存在或不存在分子四级特征方面的诊断价值。• 评估了ADC直方图特征预测组织学低级别成人弥漫性胶质瘤中分子四级的临床神经系统卫生组织级别的能力。• ADC的熵值和诊断年龄是独立预测分子四级级别的参数。• ADC直方图分析对于预测组织学低级别胶质瘤中分子四级具有价值。© 2023. 作者。

In the latest World Health Organization classification 2021, grade 4 adult diffuse gliomas can be diagnosed with several molecular features even without histological evidence of necrosis or microvascular proliferation. We aimed to explore whole tumor histogram-derived apparent diffusion coefficient (ADC) histogram profiles for differentiating between the presence (Mol-4) and absence (Mol-2/3) of grade 4 molecular features in histologically lower-grade gliomas.Between June 2019 and October 2022, 184 adult patients with diffuse gliomas underwent MRI. After excluding 121 patients, 18 (median age, 64.5 [range, 37-84 years]) Mol-4 and 45 (median 40 [range, 18-73] years) Mol-2/3 patients with histologically lower-grade gliomas were enrolled. Whole tumor volume-of-interest-derived ADC histogram profiles were calculated and compared between the two groups. Stepwise logistic regression analysis with Akaike's information criterion using the ADC histogram profiles with p values < 0.01 and age at diagnosis was used to identify independent variables for predicting the Mol-4 group.The 90th percentile (p < 0.001), median (p < 0.001), mean (p < 0.001), 10th percentile (p = 0.014), and entropy (p < 0.001) of normalized ADC were lower, and kurtosis (p < 0.001) and skewness (p = 0.046) were higher in the Mol-4 group than in the Mol-2/3 group. Multivariate logistic regression analysis revealed that the entropy of normalized ADC and age at diagnosis were independent predictive parameters for the Mol-4 group with an area under the curve of 0.92.ADC histogram profiles may be promising preoperative imaging biomarkers to predict molecular grade 4 among histologically lower-grade adult diffuse gliomas.This study highlighted the diagnostic usefulness of ADC histogram profiles to differentiate histologically lower grade adult diffuse gliomas with the presence of molecular grade 4 features and those without.• ADC histogram profiles to predict molecular CNS WHO grade 4 status among histologically lower-grade adult diffuse gliomas were evaluated. • Entropy of ADC and age were independent predictive parameters for molecular grade 4 status. • ADC histogram analysis is useful for predicting molecular grade 4 among histologically lower-grade gliomas.© 2023. The Author(s).