3D-ASL与DWI技术在脑胶质瘤术前病理分级评估及术后复发预测中的联合应用

Application of 3D-ASL and DWI in preoperative pathological grading and postoperative recurrence prediction of glioma

目的探讨三维动脉自旋标记(3D-ASL)与扩散加权成像(DWI)技术在脑胶质瘤术前临床病理分级评估及术后复发预测中的联合应用效能。方法34例脑胶质瘤患者,其中低级别脑胶质瘤13例,高级别脑胶质瘤21例。术前均行常规磁共振平扫增强、3D-ASL及DWI检查,测量3D-ASL血流灌注图像中的肿瘤实质部分最大肿瘤血流量(TBFmax)和对侧镜像区域的血流量,计算相对血流量(r CBF);同时测量肿瘤实质强化边缘外1 cm内水肿区域的平均表观扩散系数(ADC)。随访患者术后6个月的复发情况。比较术前不同病理级别、复发(术后3个月)与未复发脑胶质瘤患者r CBF及ADC值。采用ROC曲线评估ADC、r CBF及两者联合对脑胶质瘤复发的预测效能。结果3D-ASL CBF灌注图显示,高级别脑胶质瘤呈高血流灌注,低级别脑胶质瘤呈低灌注,r CBF值在高低级别脑胶质瘤之间的差异有统计学意义(t=-15.66,P<0.05);高、低级别脑胶质瘤近瘤周1 cm内水肿区的ADC值分别为(1.41±0.13)×10-3、(1.44±0.16)×10-3mm2/s,两组比较,t=0.51,P>0.05。与未复发脑胶质瘤患者比较,复发脑胶质瘤患者术前r CBF值高、ADC值低(t=-2.03,P<0.05;t=5.76,P<0.05)。3D-ASL联合DWI预测脑胶质瘤复发的AUC值最大,诊断界值分别为3.45、1.43,灵敏度及特异度分别为92.90%、85.00%。结论3DASL联合DWI可评估脑胶质瘤术前临床病理分级,并对肿瘤的复发有预测价值。

Objective To investigate the combined application of three-dimensional arterial spin labeling(3 D-ASL)and diffusion weighted imaging(DWI)in preoperative clinicopathological grading and postoperative recurrence prediction of glioma.Methods Thirty-four patients with gliomas,including 13 cases of low grade gliomas and 21 cases of high grade gliomas were selected.Before operation,the conventional MRI,3 D-ASL and DWI were performed to measure the maximum tumor blood flow(TBFmax)of tumor parenchyma and the blood flow of contralateral mirror region in 3 D-ASL perfusion images,and the relative blood flow(r CBF)was calculated.The mean apparent diffusion coefficient(ADC)of the edema area within 1 cm outside the enhancement margin of tumor parenchyma was measured.The recurrence of patients was followed up for 6 months.The r CBF and ADC values between patients with different pathological grades,and patients with or without recurrence of glioma(3 months after operation)were compared.The ROC curve was used to evaluate the predictive efficacy of ADC,r CBF and their combination for glioma recurrence.Results 3 D-ASL CBF perfusion map showed that highgrade gliomas showed high blood flow perfusion,while low-grade gliomas showed low perfusion.The difference in the r CBF value between high-grade and low-grade gliomas was statistically significant(t=-15.66,P=0.001<0.05);ADC values of edema area within 1 cm of high-grade and low-grade gliomas were(1.41±0.13),(1.44±0.16)×10-3 mm2/s,respectively.No significant difference was found between the two groups(t=0.51,P>0.05).Compared with patients without recurrent gliomas,patients with recurrent gliomas had higher r CBF and lower ADC values(t=-2.03,P=0.043<0.05;t=5.76,P=0.001<0.05).The AUC value of 3 D-ASL combined with DWI in predicting the recurrence of gliomas was the highest,with the diagnostic cut-off value of 3.45 and 1.43,and the sensitivity and specificity were 92.90%and85.00%,respectively.Conclusion 3 D-ASL combined with DWI can evaluate the preoperative clinicopathological grade of glioma and predict the recurrence of glioma.