3.0T磁共振动态对比增强扫描在脑胶质瘤分级诊断中的应用

Application of 3.0T Dynamic Contrast-enhanced MRI in the Grading of Gliomas

目的探讨3.0T磁共振动态对比增强扫描(DCE-MRI)对术前颅内胶质瘤病理分级的诊断价值。方法对40例经手术病理证实的脑肿瘤患者(其中脑胶质瘤患者29例)均行常规磁共振(MRI)及DCE-MRI检查,利用GE MR工作站的Kinetic Modeling-version 3.0软件计算颅内肿瘤实质区相应的动态灌注扫描定量参数Ktrans和Ve值,比较任意2个分级之间各定量参数差异,分析颅内不同级别胶质瘤动态增强扫描参数的特点,并利用受试者工作特性曲线(ROC)对Ktrans值及Ve值进行分析。结果应用DCE-MRI获得的定量参数ktrans值、Ve值在Ⅲ级与Ⅳ级的高级别胶质瘤均明显高于Ⅰ级与Ⅱ级的低级别胶质瘤(P<0.05);Ⅰ级与Ⅱ级,Ⅲ级与Ⅳ级胶质瘤之间Ktrans值、Ve值无统计学差异(P>0.05)。鉴别低级别胶质瘤与高级别胶质瘤Ktrans诊断阈值为0.204/min,Ve诊断阈值为0.099。区分Ⅱ级胶质瘤与Ⅲ级胶质瘤Ktrans诊断阈值为0.247/min,Ve诊断阈值为0.176。结论结合3.0T DCE-MRI的定量参数Ktrans值、Ve值及常规MRI增强扫描可以在术前区分低级别与高级别胶质瘤,也可用于区别Ⅱ级与Ⅲ级胶质瘤,而低级别胶质瘤中的Ⅰ级与Ⅱ级、高级别胶质瘤中的Ⅲ级与Ⅳ级无法鉴别,对于术前无创性评价肿瘤病理分级具有临床指导价值。

Objective To explore the clinical significance of 3.0T dynamic-contrast enhanced MRI scan in the grading of intracranial glioma.Methods The magnetic resonance examination were performed in 40 cases of patients of brain tumors confirmed by surgery pathology（29 patients with glioma）,including conventional MRI and dynamic contrast-enhanced MRI. Using Kinetic Modeling-version 3.0 software on the GE 3.0T magnetic resonance workstation calculation of intracranial tumor parenchyma area corresponding quantitative parameters Ktrans and Ve values.The quantitative parameters between any two classification were compared,and the difference was statistically analyzed. The characteristics of the different level of intracranial glioma＇s dynamic enhanced scan parameters were preliminary analyzed. The receiver-operating characteristic curve（ROC）analysis of Ktrans value and Ve value was performed,and the diagnosed threshold,sensitivity and specificity were acquired. Results While applying dynamic-contrast enhanced MRI scan acquired Ktrans and Ve values,both values of high grade gliomas include gradeⅢand Ⅳwere significantly higher than that of low grade gliomas include gradeⅠandⅡ（P〈0.05）;there was no statistically difference of the parameters of Ktrans and Ve values between gradesⅠwithⅡand gradeⅢwith Ⅳ（P〉0.05）. To identify low grade gliomas with high grade glioma,Ktrans and Ve diagnosis threshold was 0.204 /min and 0.099 respectively. To distinguish between gradeⅡ and Ⅲ glioma,Ktrans and Ve diagnosis threshold was 0.247 /min and 0.176 respectively. Conclusion Combining quantitative parameters Ktrans and Ve value that come from 3.0T dynamic contrast enhanced MRI scan with regular enhancement MRI can distinguish low grade gliomas with high grade gliomas glioma,as well as distinguish grade Ⅱ with Ⅲ glioma;However,it is still difficult to identify low grade gliomaⅠwithⅡ,as well as high grade glioma Ⅲ with Ⅳ. The Ktrans and Ve value plays an important role in discriminate different grade intracranial tumors in a preoperative noninvasive way.