动态增强磁共振成像鉴别诊断胶质瘤复发和放射性脑损伤的临床价值分析

The Clinical Value of Dynamic Enhanced Magnetic Resonance Imaging in the Differential Diagnosis of Glioma Recurrence and Radionuclide Injury

目的探讨动态增强磁共振成像(DCE-MRI)鉴别诊断胶质瘤复发(GR)和放射性脑损伤(RBI)的临床价值。方法回顾性选取2014年12月至2017年12月本院收治的胶质瘤患者86例,依据二次手术病理或临床随访结果分为GR组和RBI组,所有患者均给予DCE-MRI检查并测定脑血流动力学(Ktrans、Ve、Kep),分析其对鉴别诊断GR、RBI的临床价值。结果GR组Ktrans、Ve水平明显高于RBI组,差异有统计学意义(P<0.05),Kep在GR和RBI两组患者的水平基本相同,无显著性差异(P>0.05);在鉴别诊断GR、RBI的敏感度、特异度、准确度方面,Ktrans以0.19>min-1为临界值时为83.33%,81.58%,82.56%,Ve以>0.13%为临界值时为85.42%,78.95%,82.56%,Ktrans联合Ve时为93.75%,92.11%,93.02%,与二者单独诊断效能相比,二者联合诊断效能更佳,差异有统计学意义(P<0.05),二者单独的诊断效能相比,差异无统计学意义(P>0.05)。结论DCE-MRI检查测定Ktrans、Ve可有效鉴别诊断GR、RBI,且二者联合时具有更佳的诊断价值,值得临床作进一步推广。

Objective To discuss the clinical value of dynamic enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of glioma recurrence(GR)and radionuclide injury(RBI).Methods Retrospective study of 86 patients with glioma were selected from December 2014 and December 2017 in our Hospital,the results were divided into GR group and RBI group according to the results of secondary surgical pathology or clinical follow-up.All patients were given DCE-MRI examination and determination of cerebral hemodynamics(Ktrans,Ve,Kep).Analysis of its clinical value for differential diagnosis of GR and RBI.Results The level of Ktrans and Ve of GR group were significantly higher than that RBI group,the difference was statistically significant(P<0.05).The level of Kep was basically the sam of GR group and RBI group.In differentiating the sensitivity,specificity and accuracy of GR and RBI,when the critical value of Ktrans is 0.19>min-1,it is 83.33%,81.58%,82.56%.When the critical value of Ve is>0.13%,it is 85.42%,78.95%,82.56%.Ktrans combined Ve for 93.75%,92.11%,93.02%,compared with the diagnostic efficacy of the two methods alone,the combined diagnostic efficacy of the two methods was better,and the difference was statistically significant(P<0.05).There was no significant difference in the diagnostic efficacy of Ktrans combined with Ve(P>0.05).Conclusion DCE-MRI examination and determination of Ktrans and Ve can effectively differentiate GR and RBI,and the combination of the two has a better diagnostic value,it's worth for further clinical promotion.