磁共振IVIM和PWI技术在脑泡型包虫病诊断及其边缘带中的应用

The Application of Magnetic Resonance IVIM and PWI Technology in the Diagnosis of Cerebral Alveolar Echinococcosis and Its Marginal Zone

目的探讨IVIM-DWI与PWI技术评价脑泡型包虫病灶不同区域的血流灌注情况以及边缘区生物学活性。方法符合纳入标准的28例脑泡型包虫病患者(其中14例手术病理诊断),行头颅MRI常规检查、IVIM-DWI(16例31个有效病灶)和PWI(20例38个有效病灶)检查。测定脑泡型包虫病病灶不同感兴趣区(包括对侧正常区)的IVIM-DWI(Fast ADC、Fraction of Fast ADC)和PWI[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)]相关参数,进行统计学比较,并对病灶边缘区与对侧正常脑组织的IVIM-DWI与PWI的各参数进行ROC分析,对同时行IVIM和PWI的8例(18个病灶)进行典型相关性分析。结果实质区的Fast ADC、rCBF、rCBV、MTT值低于边缘区,F值、rCBF、rCBV、TTP差异有统计学意义(P<0.05);水肿区的Fast ADC、rCBF、rCBV、MTT值低于正常区,Fast ADC差异有统计学意义(P<0.05)。F值诊断脑泡型包虫病边缘血流灌注的曲线下面积(AUC)为0.733,rCBV的AUC为0.789,rCBF的AUC为0.853;脑泡型包虫病不同区域的IVIM和PWI参数间存在显著的线性相关性。结论脑泡型包虫病的边缘区呈高灌注,提示脑泡型包虫病边缘区具有生物学活性,IVIM和PWI能够确定脑泡型包虫病边缘增殖浸润边界,无需注射对比剂的IVIM在一定程度上可代替反映血供的PWI。

Objective To investigate the role of IVIM-DWI and PWI techniques in evaluating the blood perfusion and marginal biological activity in different areas of cerebral alveolar echinococcosis.Methods Twenty-eight patients with cerebral alveolar echinococcosis(14 of whom were diagnosed by surgical pathology)who met the inclusion criteria were examined by routine cranial MRI,IVIM-DWI(16 of whom had 31 effective lesions)and PWI(20 of whom had 38 effective lesions).Relevant parameters of IVIM-DWI(Fast ADC,Fraction of Fast ADC)and PWI(CBF,CBV,MTT,TTP)in different areas(including the contralateral normal areas)of CAE lesions were measured and statistically compared.ROC analysis was performed for each parameter of IVIM-DWI and PWI in the peripheral area and contralateral normal brain tissue,and correlation analysis was performed for 8 cases of 18 lesions undergoing IVIM and PWI simultaneously.Results The values of Fast ADC,rCBF,rCBV and MTT in the parenchymal region were lower than those in the marginal region,and the differences of F,rCBF,rCBV and TTP were statistically significant(P<0.05).The values of Fast ADC,rCBF,rCBV and MTT in the edema area were lower than those in the normal area,and the difference of Fast ADC was statistically significant(P<0.05).The AUC was 0.733,0.789 for rCBV and 0.853 for rCBF.There were significant correlations between IVIM and PWI parameters in different regions of cerebral alveolar echinococcosis.Conclusion Cerebral alveolar echinococcosis has a high perfusion in the marginal zone,suggesting that the marginal zone of cerebral alveolar echinococcosis has biological activity.IVIM and PWI can determine the border of proliferation and infiltration of cerebral alveolar echinococcosis,and IVIM.To some extent,the non-invasive IVIM without contrast agent injection could be used to replace PWI technology,which requires injection of contrast agents.