MR扩散加权成像对脑胶质瘤病理分级的临床研究

Clinical research of MR diffusion weighted imaging in pathological grading of glioma

目的探讨MR扩散加权成像对脑胶质瘤病理分级的临床应用价值。方法选择经病理证实的30例脑胶质瘤患者入组研究，患者行MR扩散加权成像，测量肿瘤实质的表观扩散系数（ADC）、相对表观扩散系数（rADC）值．并进行统计学分析。结果30例脑胶质瘤中低级别胶质瘤14例（I级1例，为毛细胞型星形细胞瘤；Ⅱ级13例，其中星形细胞瘤11例，1例为术后复发，另室管膜瘤、少突胶质细胞瘤各一例），高级别胶质瘤16例（Ⅲ级11例，均为间变性星形细胞瘤，1例为术后复发；IV级5例，其中胶质母细胞瘤4例，室管膜瘤1例）。低级别胶质瘤的ADC、rADC均值分别为（1．36±0．16）×10^-3mm^2／s、1，76±0．23，高级别胶质瘤的ADC、rADC均值分别为（1．08±0．10）×10^-3mm^2／s、1．36±0．16，高级别与低级别胶质瘤的ADC、rADC均值比较差异有统计学意义（P〈0．05）。以低级别胶质瘤肿瘤实质ADC、rADC值的下限1．20×10^-3mm^2／s、1．53作为判断阈值．本组中诊断正确率分别为86．7％、83.3％。结论ADC、rADC值对脑胶质瘤病理分级的诊断有较高的准确性。

Objective To investigate the value of MR diffusion weighted imaging （DWI） in the pathological grading of glioma, Methods Thirty patients who were confirmed pathologically with glioma were examined by MR DWI. The values of apparent diffusion coefficient （ADC） and relative ADC （rADC） were measured, All those values were analyzed statistically. Results The 30 glioma patients were divided into lower-grade and higher-grade glioma groups. The lower-grade glioma group included 14 cases （1 case of WHO I, tricholeukocyte astrocytoma; 13 cases of WHO Ⅱ, 11 astrocytomas with 1 case of post-operative recurrence, 1 ependymoma, 1 oligodendroglioma）; the higher-grade group included 16 cases （11 cases of WHO Ⅲ, anaplastic astrocytoma with 1 case of post-operative recurrence; 5 cases of WHO IV, 4 multiforme glioblastomas, 1 ependymoma）. The ADC and rADC values of lower-grade gliomas were （1.36±0.16）×10^-3 mm^2/s and 1.76±0.23, and the values of higher-grade glioma were （1.08 ±0.10） ×10^-3 mm^2/s and 1.36 ±0.16, respectively. The values of ADC and rADC were significantly different between the 2 groups （P〈0.05）. The accuracy rates were 86.7% and 83.3% when the thresholds of ADC and rADC were 1.20×10^-3 mm^2/s and 1.53. Conclusion The values of ADC and rADC have high accuracy for pathological grading of the glioma.