DCE-MRI在脑胶质瘤病理分级诊断及病变范围界定中的应用价值分析

Application Value of DCE-MRI in Pathological Grading Diagnosis and Lesion Range Definition of Brain Glioma

目的:探究动态对比增强磁共振成像(DCE-MRI)在脑胶质瘤病理分级诊断及病变范围界定中的应用价值。方法:回顾性分析2019年6月-2021年12月中国人民解放军联勤保障部队第九〇八医院收治的经手术病理证实的72例脑胶质瘤患者的临床资料,根据术中组织学病理检查结果将患者分为低级别组(Ⅱ级,n=29)和高级别组(Ⅲ、Ⅳ级,n=43)。所有患者均于术前接受磁共振成像MRI扫描,分析两组患者MRI图像特征。比较两组肿瘤实质中心区和水肿区的DCE-MRI定量参数,受试者工作特征曲线(ROC)分析DCE-MRI定量参数对脑胶质瘤病理分级的诊断价值。结果:低级别脑胶质瘤(Ⅱ级)MRI示肿瘤边界不清,T_(1)WI、T_(2)WI呈不均匀高信号,瘤周轻度水肿,局部轻度占位,伴随囊变、出血,增强后强化不明显或呈轻度不均匀强化;高级别脑胶质瘤(Ⅲ、Ⅳ级)MRI示T_(1)WI呈不均匀高信号,T_(2)WI可见明显指状水肿影,占位征象明显,伴瘤体坏死或囊变、出血,增强后呈明显花环状、结节样强化。低级别组患者实质中心区的容积转移常数(K^(trans))、血管外细胞外空间容积分数(V_(e))、速率常数(K_(ep))和相对血容量(rCBV)值均小于高级别组(P<0.05)。低级别组水肿区的rCBV值小于高级别组(P<0.05)。ROC曲线分析结果显示,DCE-MRI定量参数K^(trans)、V_(e)、K_(ep)和rCBV诊断不同病理分级脑胶质瘤的AUC值分别为0.795、0.840、0.881和0.782。结论:DCE-MRI在脑胶质瘤病理分级诊断及病变范围界定中均具有良好的应用价值,定量参数K^(trans)、V_(e)、K_(ep)和rCBV是鉴别高、低级别脑胶质瘤的可靠指标,rCBV在病变范围的界定方面更具有诊断价值。

Objective:To explore the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in pathological grading diagnosis and lesion range definition of brain glioma.Method:The clinical data of 72 patients with brain glioma confirmed by surgery and pathology admitted to the 908th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from June 2019 to December 2021 were retrospectively analyzed,according to the histopathological results,the patients were divided into low-grade group(gradeⅡ,n=29)and high-grade group(gradeⅢ,Ⅳ,n=43).All patients underwent MRI scanning before surgery,and the MRI features were analyzed.The DCE-MRI quantitative parameters in central area and edema area of tumor parenchyma were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the value of DCE-MRI quantitative parameters in pathological grading diagnosis of brain glioma.Result:For low-grade(gradeⅡ)brain gliomas,MRI showed obscure tumor boundaries,heterogeneous high signals on T_(1)WI and T_(2)WI,mild edema around the tumor,mild local space occupying signs,with cystic degeneration and hemorrhage.The enhancement was not obvious or slightly heterogeneous after enhanced scan.For high-grade(gradeⅢ,Ⅳ)brain gliomas,MRI showed heterogeneous high signal on T_(1)WI,obvious finger-like edema on T_(2)WI,obvious space-occupying signs,with tumor necrosis,cystic degeneration or hemorrhage,the enhancement was ring-like and nodular after enhanced scan.The volume transfer constant(K^(trans)),extravascular extracellular space volume fraction(V_(e)),rate constant(K_(ep))and relative cerebral blood volume(rCBV)in parenchymal central area of the low-grade group were lower than those of the high-grade group(P<0.05).The rCBV value in edema area of the low-grade group was lower than that of the high-grade group(P<0.05).ROC curve analysis showed that the AUC values of DCE-MRI quantitative parameters K^(trans),V_(e),K_(ep) and rCBV to diagnose different pathological grades of brain gliomas were 0.795,0.840,0.881 and 0.782,respectively.Conclusion:DCE-MRI has a good application value in the pathological grading diagnosis and lesion range definition of brain glioma.The quantitative parameters K^(trans),V_(e),K_(ep) and rCBV can are reliable indicators for distinguish high-grade and low-grade brain gliomas,and rCBV has more diagnostic value for lesion range definition.