多模态磁共振成像对脑胶质瘤及病理分级的诊断价值研究

Diagnostic Value of Multimodal Magnetic Resonance Imaging in Glioma and Pathological Grading

目的探讨术前多模态磁共振成像(magnetic resonance imaging,MRI)对脑胶质瘤及病理分级的诊断价值,为脑胶质瘤的精准手术治疗提供重要参考依据。方法选择2019年4月至2021年4月于海南省中医院治疗的脑胶质瘤患者100例,术后根据肿瘤病理结果分为低级别组(Ⅰ~Ⅱ级)42例和高级别组(Ⅲ~Ⅳ级)58例。所有患者均完善常规MRI及动态对比增强MRI(dynamic contrast-enhanced MRI,DCE-MRI)、弥散加权成像(diffusion weigh imaging,DWI)及灌注成像(perfusion weighted imaging,PWI)检查。分析不同级别脑胶质瘤患者常规MRI及DCE-MRI、DWI及PWI参数,采用多因素Logistic回归分析筛选高级别胶质瘤的影响因素,采用受试者工作特征曲线(receiver operating characteristic,ROC)分析DWI及PWI参数值[表观弥散系数(apparent diffusion coefficient,ADC)值、脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit time,MTT)和达峰时间(time to peak,TTP)]对高级别脑胶质瘤的诊断价值。结果与低级别组相比,高级别组患者在直径大小、囊变坏死、出血、边界清晰度、水肿、强化程度上差异有统计学意义(P<0.05);与低级别组相比,高级别组患者ADC值明显下降,CBF、CBV、MTT和TTP值明显升高(P<0.05);多因素Logistic回归分析表明了肿瘤囊变坏死、出血、水肿、强化程度等影像学特征和ADC、CBF和CBV值是高级别脑胶质瘤患者的独立危险因素(P<0.05);ROC曲线示,DWI参数(ADC)及PWI参数(CBF、CBV、MTT和TTP)对高级别脑胶质瘤患者具有诊断价值(P<0.05),其中ADC值的诊断效能最大,其曲线下面积最大。结论多模态MRI技术有助于高级别脑胶质瘤的判断,其ADC值下降,CBF、CBV、MTT和TTP值升高。

Objective To investigate the diagnostic value of preoperative multimodal magnetic resonance imaging(MRI)in glioma and pathological grading,and to provide an important reference for accurate surgical treatment of glioma.Methods A total of 100 patients with glioma treated in Hainan Traditional Chinese Medicine Hospital from April 2019 to April 2021 were selected.According to the pathological results of the tumor,they were divided into 42 cases of the low⁃grade group(Ⅰ~Ⅱgrade)and 58 cases of the high⁃grade group(Ⅲ~Ⅳgrade).Routine MRI,dynamic contrast⁃enhanced MRI(DCE⁃MRI),diffusion weigh imaging(DWI),and perfusion⁃weighted imaging(PWI)were performed in all patients.The parameters of routine MRI,DCE⁃MRI,DWI,and PWI in glioma patients of different grades were analyzed,and multivariate Logistic regression analysis was used to screen the influencing factors of highgrade glioma,DWI and PWI parameter value[apparent diffusion coefficient(ADC)value,cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)]for the diagnosis of high⁃grade gliomas were analyzed by receiver operating characteristic(ROC).Results Compared with the low⁃grade group,there were statistically significant differences in diameter,cystic necrosis,hemorrhage,boundary clarity,edema,and degree of enhancement in the high⁃grade group(P<0.05);Compared with the low⁃grade group,ADC value of the high⁃grade group was significantly decreased,while CBF,CBV,MTT,and TTP values were significantly increased in the high⁃grade group(P<0.05).Regression analysis showed that imaging characteristics of tumor cystic necrosis,hemorrhage,edema,degree of enhancement,ADC,CBF and CBV values were independent risk factors for high⁃grade glioma patients(P<0.05);ROC curve showed that DWI parameters(ADC)and PWI parameters(CBF,CBV,MTT and TTP)had diagnostic value for patients with high⁃grade glioma(P<0.05),among which ADC value had the highest diagnostic efficiency and its area under curve was the largest.Conclusions Multimodal MRI technique is helpful for the diagnosis of high⁃grade glioma,with the decrease of ADC value and the increase of CBF,CBV,MTT,and TTP value.