MRI对高低级别胶质瘤的鉴别效能及诊断价值研究

Study on the differential efficacy and diagnostic value of MRI in high and low grade gliomas

目的探讨MRI对高低级别胶质瘤的鉴别效能及诊断价值。方法选取2016年7月~2019年7月在我院就诊的脑胶质瘤患者80例,所有患者均经手术或穿刺病理证实。以病理检查结果为金标准,所有患者均进行MRI扫描和增强扫描,统计患者疾病检出率,ASL图像分析所有患者血流量(TBF)值、正常白质的血流量(BFWM)值、相对血流值(rTBF)、脑血流量(CBF),并进行不同级别脑胶质瘤血流指标诊断效能诊断。结果以病理结果为“金标准”,其中少突胶质细胞瘤14例,星形细胞瘤50例,胶质母细胞瘤6例,室管膜瘤10例。高级别脑胶质瘤检出率高于低级别脑胶质瘤检出率,差异有统计学意义(P<0.05)。高级别脑胶质瘤患者血流量、相对血流值、CBF高于低级别脑胶质瘤患者,差异有统计学意义(P<0.05)。低级别脑胶质瘤与高级别脑胶质瘤BFWM比较,差异无统计学意义(P>0.05)。血流量和相对血流值对胶质瘤不同级别诊断其AUC为0.955和0.970,当最佳临界值为58.65 ml/min和1.386时是最佳的鉴别诊断效能,其敏感度和特异度最高。结论MRI在胶质瘤的鉴别中,能将高低级别胶质瘤区分开,检出率较高,提高了诊断价值,值得临床推广应用。

Objective To explore the differential efficacy and diagnostic value of MRI in high and low grade gliomas.Methods From July 2016 to July 2019,80 patients with gliomas were selected.All patients were confirmed by operation or puncture pathology.According to the gold standard of pathological examination,all patients were scanned with MRI and enhanced scanning,and the disease detection rate was counted.The blood flow(TBF),normal white matter(bfwm),relative blood flow(rtbf)and cerebral blood flow(CBF)of all patients were analyzed by ASL image,and the diagnosis efficacy of different levels of cerebral glioma blood flow index was diagnosed.Results According to the"gold standard"of pathological examination,14 cases were oligodendrocytoma,50 were astrocytoma,6 were glioblastoma and 10 were ependymoma.The detection rate of high grade gliomas was higher than that of low grade gliomas(P<0.05).The blood flow,relative blood flow and CBF of patients with high-grade glioma were higher than those of patients with low-grade glioma(P<0.05).There was no significant difference in bfwm between low grade gliomas and high grade gliomas(P>0.05).The AUC of different grades of gliomas was 0.955 and 0.970 for blood flow and relative blood flow.When the best critical value was 58.65ml/min and 1.386,it was the best differential diagnosis efficiency,with the highest sensitivity and specificity.Conclusion MRI can distinguish the high and low grade gliomas in the differential diagnosis of gliomas.It has a high detection rate,improves the diagnostic value,has a high clinical application value,which is worth popularizing.