3D-ASL在脑胶质瘤术后放疗后复发以及放射性脑损伤中的诊断应用

Application of 3D-ASL in the diagnosis of recurrence and radiation brain injury after radiotherapy of brain glioma

目的探讨3D-ASL在脑胶质瘤术后放疗后复发以及放射性脑损伤中的诊断应用。方法选取2016年1月至2018年5月本院收治的脑胶质瘤术后放疗后复发患者38例,所有患者采取常规MRI增强扫描与3D-ASL检查,按照术后复发与放射性损伤分为术后复发组(16例)与放射性损伤组(22例),放疗诊断异常强化区域与侧正常脑组织的脑血流量(CBF)值与强化病灶中心区、边缘区的平均脑血流量(rCBF)、相对平均表现扩散系数(rADC)比值。结果38例采取常规MRI增强扫描后显示异常强化灶,其中术后复发16例,放射性损伤22例;复发患者平均rCBF值(2.18±0.27)与放射性脑损伤患者平均rCBF值(0.89±0.22),组间差异有统计学意义(P<0.05);复发患者强化中心区、边缘区的rCBF值显著高于放射性脑损伤患者;复发患者rADC比值显著低于放射性脑损伤患者,组间差异有统计学意义(P<0.05)。结论脑胶质瘤的复发与放射性脑损伤会导致病变区域局部血脑屏障显著侵损,且造影剂集中于局部,显示局部强化与周围水肿,3D-ASL以水为内源性示踪剂进行分散,掌握病变区域微血管密度与血流灌注现状,是诊断胶质瘤术后、放疗后肿瘤复发与放射性脑侵害的有效方式。

Objective To investigate the application of 3D-ASL in the diagnosis of recurrence and radiation brain injury after radiotherapy of brain glioma.Methods During January 2016 to May 2018,38 patients with recurrent after radiotherapy of brain glioma who were admitted to the hospital were enrolled.All patients underwent routine MRI-enhanced scanning and 3D-ASL examination.According to postoperative recurrence and radioactive injury,they were divided into postoperative recurrence group(n=16)and radiation injury group(n=22).The radiotherapy was performed to diagnose cerebral blood flow(CBF)in abnormally enhanced areas and lateral normal brain tissues,regional cerebral blood flow(rCBF)and relative apparent diffusion coefficient(rADC)in the central and marginal areas of intensive lesions.Results 38 patients undergoing routine MRI-enhanced scanning showed abnormal enhancement lesions,including 16 cases with postoperative recurrence,and 22 cases with radiation injury.The average rCBF value in recurrent patients and patients with radiation brain injury were(2.18±0.27)and(0.89±0.22),respectively(P<0.05).The rCBF values in intensive central and marginal areas of recurrent patients were significantly higher than those of patients with radiation brain injury,while rADC ratio was significantly lower than that of patients with radiation brain injury(P<0.05).Conclusion The recurrence of brain glioma and radiation brain injury can cause significant damage to local blood-brain barrier in lesion areas.And the contrast agent is concentrated locally,showing local enhancement and peripheral edema.3D-ASL is disperses with water as an endogenous tracer agent.Mastering the microvessel density and blood flow perfusion status in the lesion areas is an effective way to diagnose tumor recurrence and radiation brain damage after glioma surgery and radiotherapy.