动脉自旋标记在脑肿瘤分级评估中的诊断意义

Diagnostic significance of arterial spin labeling in the assessment of tumor grade in brain

目的探讨通过动脉自旋标记(arterial spin labeling,ASL)灌注成像技术测量脑肿瘤患者脑血流量(cerebral blood flow,CBF)对于脑肿瘤术前分级的价值。方法选择PubMed、Web of Science、Embase、中国医药研究(China BioMedicine,CBM)、CINAHL、Cochrane Library和中国知网(China National Knowledge Internet,CNKI)等数据库检索相关文献,评价ASL和脑肿瘤之间的关联。将独立对纳入研究的质量进行评估,并将计算各研究的标准化均差(standard deviation,SMD)及其95%置信区间(confidence interval,CI)。结果本次Meta分析共纳入来自12项研究的475例患者,并对其进行了统计分析。结果表明,高级别脑肿瘤患者的肿瘤相对血流量(tumor relative blood flow,rTBF)和大脑相对血流量(relative cerebral blood flow,rCBF)显著高于低级别脑肿瘤患者。按国家分层的亚组分析发现,在美国、韩国和中国的高级别脑肿瘤患者中,高rTBF值是ASL的主要预测手段;在美国和中国结合ASL成像技术发现,高级别脑肿瘤患者的rCBF值更高。进一步的亚组分析发现,所有亚组中rTBF值与高级别肿瘤呈正相关,而rCBF值仅在白质组中呈正相关。结论高级别脑肿瘤患者的rTBF和rCBF值更高,提示ASL可用于脑肿瘤分级时的鉴别诊断。

Objective To assess the arterial spin labeling（ASL）perfusion imaging measurement of cerebral blood flow（CBF）in patients with brain tumors,and assessing preoperative tumor grade in brain.Methods PubMed,Web of Science,Embase,China BioMedicine（CBM）,CINAHL,Cochrane Library,and China National Knowledge Infrastructure（CNKI）databases were chosen to evaluate the associations between ASL and brain cancer.The quality of the included trials was evaluated.Standardized mean difference（SMD）at 95% confidence interval（95% CI）was also calculated.Results Four hundreds and seventy five patients were enrolled into this Meta-analysis from 12 eligible studies and were selected for statistical analysis.Results showed that relative tumor blood flow（rTBF）and relative cerebral blood flow（rCBF）in high-grade brain cancer patients were faster than those in low-grade brain cancer patients.Subgroup analysis stratified by country implied that ASL may be the main prediction of increased rTBF in high-grade brain cancer patients among USA,Korea and China;and rCBF was faster in high-grade brain cancer using ASL in USA and in China.Further reference by tissue-stratified analysis revealed a positive association of rTBF with high-grade brain cancer by utilization of ASL in all the experimental subgroups,while rCBF was only correlated in white subgroups.Conclusion These results showed that rTBF and rCBF were faster in high-grade brain cancer patients,suggesting that ASL may provide suitable measurement for the differential diagnosis of tumor grade in brain.