MRI多模态成像对脑胶质瘤术后放疗患者的评估

Multimodal MRI Evaluation of Patients with Glioma Undergoing Radiotherapy after Operation

目的:探讨MRI多模态成像(常规MRI平扫+增强、弥散加权成像(DWI)、灌注加权成像(PWI)等)在脑胶质瘤术后复发与放射性坏死诊断中的价值。方法:回顾性分析2016年3月~2019年3月我院收治的胶质瘤术后放疗60例患者临床资料,包括一般资料、影像学检查资料。所有患者均行MRS、DWI以及PWI影像学检查,记录影像学特征、相对表观扩散系数(rADC)、相对脑血容量(rCBV)以及相对脑血流量(rCBF)指标。结果:胶质瘤复发与放射性坏死患者rCBF与rCBV值差异比较具有统计学意义(t=6.307,6.428,P<0.05),rADC差异比较无统计学意义(t=0.821,P>0.05)。MRI的胶质瘤复发诊断灵敏度为72.22%,放射性坏死诊断灵敏度为63.64%,准确率分别为91.67%、93.33%;PWI检测胶质瘤复发和放射性坏死的灵敏度分别为77.78%、72.73%,准确率分别为93.33%、95.00%;MRI联合PWI检测胶质瘤复发和放射性坏死的灵敏度分别为88.89%、90.91%,准确率分别为96.67%、98.33%。结论:MRI多模态成像联合检测可提高脑胶质瘤术后放疗患者的病情鉴别诊断准确率和灵敏度,为其进行针对性治疗提供临床依据。

Objective:To explore the value of multimodal MRI(conventional MRI plain scan + enhanced scan, diffusion weighted imaging(DWI), perfusion weighted imaging(PWI), etc.) in the diagnosis of postoperative recurrence and radiation necrosis of glioma.Methods:General clinical data and imaging data of 60 patients with glioma who underwent radiotherapy after operation in the hospital between March 2016 and March 2019 were retrospectively analyzed. All of them completed MRS, DWI and PWI examinations. Imaging characteristics, relative apparent diffusioncoefficient(rADC), relative cerebral blood volume(rCBV) and relative cerebral blood flow(rCBF) were recorded.Results:Differences inrCBF and rCBVbetween patients with recurrent glioma and radiation necrosis were statistically significant(t=6.307, 6.428, P<0.05), but the difference in rADC was not statistically significant(t=0.821, P>0.05). Sensitivities of MRI in diagnosis of recurrent glioma and radiation necrosis were 72.22% and 63.64%, respectively. The accuracy rates were91.67% and 93.33%. Sensitivities of PWI in detection of recurrent glioma and radiation necrosis were 77.78% and 72.73%, respectively. The accuracy rateswere 93.33% and 95.00%. Sensitivities of MRI combined with PWIin detection of recurrent glioma and radiation necrosis were88.89% and 90.91%, respectively. The accuracy rateswere 96.67% and 98.33%.Conclusion:Multimodal MRI can improve the accuracy and sensitivity of differential diagnosis of patients with glioma after radiotherapy, which provides clinical evidence for targeted treatment.