术前动态磁敏感对比增强MR灌注加权成像在脑胶质瘤预后评估中的价值研究

Prognostic value of preoperative dynamic susceptibility contrast-enhanced MR imaging in patients with gliomas

目的探究术前动态磁敏感对比增强MRI(dynamic susceptibility contrast MRI,DSC-MRI)相对脑血流量(relative cerebral blood volume,rCBV)最大值(rCBV_(max))与胶质瘤患者总生存期(overall survival,OS)的相关性。材料与方法回顾性分析2013年1月至2016年12月62例经手术病理确诊为胶质瘤患者资料,术前均行DSC-MRI检查。选取本组病例rCBV_(max)值的中位数进行定量分析。采用Kaplan-Meier法计算生存率,并采用Log-rank检验进行生存比较;多因素分析则采用Cox比例风险模型进行危险因素判断。结果 KaplanMeier生存曲线表明,rCBV_(max)≥4.47组患者中位OS明显短于rCBV_(max)<4.47组(P<0.001);低级别胶质瘤(low-grade glioma,LGG)中位OS明显长于高级别胶质瘤(high-grade glioma,HGG)(P=0.001);同时纳入病理级别与rCBV_(max)值,结果发现LGG+rCBV_(max)<4.47组预后最佳(P<0.05),LGG+rCBV_(max)≥4.47组与HGG+rCBV_(max)<4.47组间差异无统计学意义(P=0.154),HGG+rCBV_(max)≥4.47组预后最差(P<0.05)。多因素分析表明rCBV_(max)与胶质瘤预后独立相关(P=0.001)。结论 rCBV_(max)可作为胶质瘤患者的独立预后指标,指导临床个体化治疗。

Objective:To investigate the relationship of maximum value of relative cerebral blood volume(rCBV)from dynamic susceptibility contrast-enhanced MRI(DSC-MRI)to prognosis in patients with gliomas.Materials and Methods:We conducted a retrospective analysis of the preoperative perfusion MR imaging in 62 histologically confirmed gliomas.Median relative CBV values were selected for quantitative analysis.Survival analysis was made by constructing survival curves using the Kaplan-Meier method with subgroups compared by Log-rank probability tests.A Cox regression model was made for multivariate analysis.Results:Kaplan-Meier survival curves demonstrated that overall survival of high rCBVmax(≥4.47)was significantly shorter than that of low rCBVmax(<4.47)(P<0.001),overall survival of low-grade glioma was significantly longer than that of high-grade glioma(P=0.001).Incooperating rCBVmax and pathological grade,the prognosis was best for the group of LGG+rCBVmax<4.47 and worst for the group of HGG+rCBVmax≥4.47.No significant difference was found between the group of LGG+rCBVmax≥4.47 and HGG+rCBVmax<4.47(P=0.154).Multivariate analysis suggested that rCBVmax was associated with survival independent of pathology(P=0.001).Conclusions:The rCBVmax value may be an independent indicator of prognosis in patients with glioma and an adjunct to WHO grading to determine clinical individual treatment.