PWI对胶质瘤术后复发与放射性脑损伤的鉴别诊断

Clinical application of PWI in the differential diagnosis of recurrent brain glioma and radiation-induced brain injury

目的探讨的磁共振灌注成像(PWI)应用于胶质瘤术后复发和放射性脑损伤的鉴别诊断价值。方法选择2013年5月~2016年1月期间在我院行磁共振检查经手术治疗后放疗的52例脑胶质瘤患者,对进行放疗治疗后影像检查中首次出现异常强化病灶的患者进行MRI以及PWI检查,测量病灶区域的最大相对脑血容量(r CBVmax)数值,并分析PWI技术对脑胶质瘤以及放射性损伤两者的鉴别价值。结果在52例患者中,其中30例属于脑胶质瘤复发,其余22例则是放射性损伤,MRI检查的诊断准确率是38.46%,复发病灶r CBVmax为(2.51±1.54),放射性损伤r CBVmax仅有(0.68±0.37),两者差异显著(P﹤0.05);而PWI检查中发现诊断准确率高达80.77%,和MRI相比,其诊断准确率有显著优势,差异显著(P﹤0.05)。结论对于脑胶质瘤术后放疗患者,若不能有效鉴别放射性损伤以及复发,可以在MRI检查基础上再予PWI技术检查,能够显著提高诊断准确率,为临床提供更多参考指导意义。

Objective To study the clinical application of PWI （perfusion weighted imaging） in the differential diagnosis of recurrent brain glioma and radiation-induced brain injury. Methods 52 patients with brain glioma treated fi＇om May 2013 to January 2016 in our hospital were selected. After the radiotherapy, the patients with the abnormal enhancing lesions received the MRI and PWI examination. The index of rCBVmax in the focal regions was counted; the application value of PWI in the differential diagnosis of recurrent brain glioma and radiation-induced brain injury was analyzed. Results For 52 cases, there were 32 cases with recurrent brain glioma and 22 cases with radiation-induced brain injury. The accuracy of MRI examination was 38.46%; the index of rCBVmax for patients with recurrent brain glioma was （2.51±1.54）; the index of rCBVmax for patients with radiation-induced brain injury was rCBVmax was （0.68±0.37） （P〉0.05）; The accuracy of MRI examination was 80.77%. The accuracy of MRI examination was higher than that of MRI examination （P 〈 0.05）. Conclusion After the radiotherapy, the combined method of MRI and PWI examination is good to make a differential diagnosis of radiation-induced brain injury and recurrent brain glioma, can greatly improve the clinical diagnosis rate. It is of great importance in clinical practice.