MRI弥散成像技术序列表观扩散系数图在高级别脑胶质瘤术后假性进展或肿瘤复发鉴别诊断中的价值

The value of MRI diffusion imaging sequence apparent diffusion coefficient map in the differential diagnosis of pseudoprogression or tumor recurrence after high-grade glioma surgery

目的探讨磁共振(MRI)弥散成像技术(Diffusion)序列表观扩散系数(ADC)图在高级别脑胶质瘤(HGG)术后假性进展或肿瘤复发鉴别诊断的价值。方法回顾性选取2020年1月至2022年1月九江市第三人民医院和九江市第一人民医院收治的58例HGG患者作为研究对象,根据其经二次手术或术后随访结果分为肿瘤复发组(28例)和假性进展组(30例),均于术后完善颅脑MRI平扫+增强检查,收集其术后1、3个月相关影像学资料,汇总分析两组患者ADC图像信息,测量两组患者强化病灶中心区、强化病灶边缘区及对侧镜像区的ADC值,比较两组患者强化病灶中心区、强化病灶边缘区ADC值及其相对表观扩散系数(rADC)值。结果肿瘤复发组ADC图像信号整体低于假性进展组,差异有统计学意义(P<0.05)。肿瘤复发组术后1、3个月的强化病灶中心区及边缘区ADC值及rADC值均低于假性进展组,差异有统计学意义(P<0.05);肿瘤复发组术后3个月强化病灶中心区及边缘区ADC值及rADC值均低于本组术后1个月,差异有统计学意义(P<0.05);假性进展组术后3个月强化病灶中心区及边缘区ADC值及rADC值与本组术后1个月比较,差异无统计学意义(P>0.05)。ROC曲线分析显示,术后3个月强化病灶中心区及边缘区rADC值均有鉴别肿瘤复发和假性进展价值(AUC=0.770、0.710,P<0.05),此时截断值分别为0.91和0.89。以强化病灶中心区及边缘区rADC值截断值为临界值,采用串联的方式进行联合检测,评估鉴别肿瘤复发和假性进展价值,其AUC为0.789,敏感度为67.86%,特异度为90.00%,联合检测AUC及特异度均高于各指标单独检测。结论高级别胶质瘤术后采用Diffusion序列ADC图进行分析对鉴别HGG术后肿瘤复发和假性进展具有一定的临床价值。

Objective To explore the value of MRI diffusion imaging sequence(Diffusion)apparent diffusion coefficient(ADC)map in the differential diagnosis of pseudoprogression and tumor recurrence after high-grade glioma(HGG)surgery.Methods A total of 58 patients with HGG admitted to Jiujiang First People's Hospital and Jiujiang Third People's Hospital between January 2020 and January 2022 were selected retrospectively as research objects.According to the results of secondary surgery or postoperative follow-up,they were divided into tumor recurrence group(28 cases)and pseudo-progression group(30 cases).All patients completed brain MRI plain scan and enhancement examinations after surgery.The related imaging data were collected at 1 and 3 months after surgery.The information of ADC images in both groups was collected and analyzed.ADC values in central enhancement lesion area,marginal enhancement lesion area and contralateral mirror area in both groups were measured. ADC values and relative apparent diffusion coefficient (rADC) values in central enhancement lesion area and marginal enhancement lesion area were compared between the two groups. Results ADC image signal in tumor recurrence group was lower than that in pseudo-progression group, the difference was statistically significant (P<0.05). At 1 and 3 months after surgery, ADC and rADC values in central and marginal enhancement lesion areas in tumor recurrence group were lower than those in pseudo-progression group, the differences were statistically significant (P<0.05). ADC and rADC values in central and marginal enhancement lesion areas of tumor recurrence group at 3 months after surgery were lower than those at 1 months after surgery, the differences were statistically significant (P<0.05). There were no significant differences in ADC and rADC values in central and marginal enhancement lesion areas in pseudo-progression group at 1 and 3 months after surgery (P>0.05). ROC curves analysis showed that rADC values in central and marginal enhancement lesion areas at 3 months after surgery were of differential diagnosis value for tumor recurrence and pseudoprogression (AUC=0.770, 0.710, P<0.05), and their cut-off values were 0.91 and 0.89 respectively. Taking the cut-off values of rADC values in central and marginal enhancement lesion areas as the critical values, and the combined detection was conducted in tandem to evaluate the value of differentiating tumor recurrence and pseudo progression. AUC, sensitivity and specificity of rADC value in central enhancement lesion area combined with rADC value in marginal enhancement lesion area (tandem mode) in the differential diagnosis of pseudoprogression and tumor recurrence were 0.789, 67.86% and 90.00%, respectively. AUC and specificity of combined detection were higher than those of single index. Conclusion Diffusion sequence ADC images are of certain value in the differential diagnosis of pseudoprogression and tumor recurrence after HGG surgery.