3D动脉自旋标记成像在神经胶质瘤术前分级中的应用价值

3D Arterial Spin Labeling MR Imaging Technique in Gliomas:Efficacy in Preoperative Grading

目的评估基于FSE的3D-动脉自旋标记(3D-ASL)在神经胶质瘤术前分级中的应用价值。方法选择35例疑似脑胶质瘤的患者为研究对象,术前均行MR常规、3D-ASL及MR脑灌注-动态磁敏感对比成像(DSC)。分别测得DSC和3D-ASL两种方法中的肿瘤实质部分最大相对血流量(r TBFmax)。将这两种方法得到的r TBFmax做差异分析(t检验);用两独立样本秩和检验分别比较ASL及DSC产生的r TBFmax在不同级别胶质瘤之间有无统计学差异。结果 35例患者中病理证实的脑胶质瘤患者高级别胶质瘤18例(WHOⅣ级11例,Ⅲ级7例),低级别胶质瘤13例(WHOⅡ级)。r TBFmax值在3D-ASL和DSC两种技术之间的差异无明显统计学意义(P>0.05)。3 D-A S L法测得的r T B Fm a x值,高、低级别胶质瘤分别为(2.3 4±1.2 1)、(0.69±0.36),DSC法测得的r TBFmax值分别为(2.55±1.06)、(0.72±0.52),差异均有统计学意义(P<0.01)。结论 3DASL可成为胶质瘤血流动力学的常规评估方法,将其与常规MRI扫描联合用于术前胶质瘤级别的评估会提高脑胶质瘤分级诊断的准确性。

Objective To retrospectively assess the efficacy of 3D arterial spin labeling（3DASL） based on fast spin echo（FSE） technique in the preoperative grading of glioma.Methods Thirty-five patients who were suspected with glioma clinically underwent conventional MR imaging, 3D-ASL, and dynamic susceptibility contrast（DSC） imaging.The DSC and 3D ASL-derived index relative maximal tumor blood flow（r TBFmax） were generated from the tumors. Student t test was used to compare r TBFmax between 3D-ASL and DSC. Wilcoxon rank sum test was used to compare 3D-ASL and DSC-MRI indices for differences between low- and high- grade gliomas. Results The histological diagnosis of excised tumor from the 35 patients included in this study demonstrated that 18 patients had high-grade gliomas（11 had WHO grade IV, 7had WHO III）, and 13 had low-grade gliomas（ Had WHO II）. On Student t test, there was no significant difference between3D-ASL and DSC-derived r TBFmax（P〉0.05）. There were significant differences between high- and low- grade glioma r TBFmax（P〈0.01） for the two methods of3D-ASL and DSC in high- and low- grade gliomas were respectively（2.34±1.21）,（0.69±0.36）,（2.55±1.06） and（0.72±0.52）. Conclusion 3D-ASL can be utilized as a routine technique for evaluating the hemodynamics of gliomas. The combination of 3DASL and conventional MR imaging may improve the accuracy of preoperative grading in glioma.