磁共振ASL技术在鉴别高级别脑胶质瘤治疗后假性进展中的应用

Application of MRI ASL in Identifying Pseudothe Science, Technology & Innovation Commission of Shenzhen Municipality-progression of High Grade Glioma after Treatment

目的探讨MRI动脉自旋标记(ASL)技术对高级别胶质瘤术后放化疗患者假性进展与复发的诊断价值。方法应用3.0TMR对32例术后和放化疗后的随访MR中发现新的异常强化灶的高级别胶质瘤患者进行2DpASL检查。患者基于随后的病理分析或临床放射学随访被分为假性进展组(n=7)和胶质瘤复发组(n=25)。使用Wilcocon秩和检验比较两组之间的损伤灌注参数值rCBF。ROC曲线评估rCBF在复发假性进展中的诊断性能。结果对比增强病变中,假性进展组的rCBF显着低于胶质瘤复发组((1.45±0.25)对(3.16±0.14)Z=-3.739,P=0.000)rCBF在假性进展诊断中ROC曲线下面积为0.765(95%置信区间:0.597-0.932),灵敏度为0.647,特异性为0.733。结论 ASL有助于区分治疗后常规随访MRI的新发展增强病变的高级别胶质瘤患者的假性进展和复发。

Objective To investigate the diagnosis performance of arterialspin labeling(ASL in distinguishing pseudoprogression from recurrence in postoperation chemoradiotherapy patients with high-grade glioma.Methods 2 D pASL was performed using a 3.0 Tesla scanner in 32 patients with high-grade glioma,who received previously resection and chemoradiotherapy,and newly developed abnormal contrast-enhanced lesions were noted at rountine following-up MRI.These patients were classified into a pseudoprogression group(n=7)and glioma recurrence group(n=25)based on subsequent pathologic analysis or clinical–radiological follow-up.Lesion perfusion parameter values-rCBF was compared between the two groups using Wilcocon rank sum test.The diagnosis performance of rCBF in distiguishing pseudoprogression from recurrence were assessed receiptor operation characteristic(ROC)curve.Results For the contrast-enhanced lesions,the rCBF in the pseudoprogression group was significantly lower than that in the glioma recurrence group((1.45±0.25)vs(3.16±0.14)Z=-3.739,P=0.000)The area under the ROC curve was 0.765(95%confidence interval:0.597-0.932)with a sensitivity of 0.647 and a specificity of 0.733 for rCBF in diagnosis of pseudoprogression.Conclusion ASL is helpful in differentiating pseudoprogression from recurrence in high grade giloma patients with newly development enhanced lesions during routine following-up MRI after therapy.