DCE-MRI、IVIMDWI、MRS技术在脑胶质瘤术后复发与假性进展鉴别诊断中的应用价值

Application value of DCE-MRI,IVIM-DWI and MRS in the Differential Diagnosis o f Postoperative Recurrence and Pseudoprogression of Glioma

目的分析动态对比增强磁共振成像(DCEMRI)、体素内不相干运动扩散加权成像(IVIMDWI)、磁共振波谱成像(MRS)技术在脑胶质瘤术后复发与假性进展(PP)鉴别诊断中的应用价值。方法选取本院72例术后同步放化疗脑胶质瘤患者,均于放化疗后3个月接受DCE-MRI、IVIM-DWI与MRS检查,按照二次手术病理学检查或随访结果,将其分为复发组与PP组,比较两组转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)、表观扩散系数(ADC)、灌注分数(f)、真性扩散系数(D)与假性扩散系数(D)、胆碱(Cho)/磷酸肌酸(Cr)、Cho/N乙酰天门冬氨酸(NAA),使用受试者工作特征(ROC)曲线分析各指标联合对术后复发与PP的鉴别价值。结果两组Kep、D、D比较无统计学意义(P>0.05);复发组Ktrans、Ve、f、Cho/Cr、Cho/NAA显著高于PP组(P<0.05),ADC显著低于PP组(P<0.05);ROC分析显示,Ktrans、Ve、f、ADC、Cho/Cr、Cho/NAA及联合诊断AUC分别为0.688、0.821、0.835、0.679、0.801、0.785、0.988,其中联合诊断AUC最大,鉴别复发与PP的敏感度95.32%,特异度93.07%。结论DCE-MRI、IVIM-DWI联合MRS对脑胶质瘤术后复发与PP具有较高诊断效能,可为临床更好鉴别肿瘤复发与PP提供可靠指导。

Objective To analyze the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)and magnetic resonance spectroscopy(MRS)in the differential diagnosis of postoperative recurrence and pseudoprogression(PP)of glioma.Methods Seventy-two patients with glioma who underwent concurrent radiochemotherapy in the hospital were selected.All patients were examined with DCEMRI,IVIM-DWI and MRS after 3 months of radiochemotherapy.According to the second surgical and pathological results or follow-up results,the patients were divided into recurrence group and PP group.The transfer coefficient(Ktrans),rate constant(Kep),volume fraction of extravascular extracellular space(Ve),apparent diffusion coefficient(ADC),perfusion fraction(f),true diffusion coefficient(D),false diffusion coefficient(D),choline(Cho)/creatine phosphate(Cr)and Cho/N-acetylaspartic acid(NAA)were compared between the groups.The value of the combination of these indicators in the differential diagnosis of postoperative recurrence and PP was analyzed using the receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in Kep,D or D between the groups(P>0.05).Ktrans,Ve,f,Cho/Cr and Cho/NAA in the recurrence group were significantly higher than those in the PP group(P<0.05).ADC value was significantly lower than that in the PP group(P<0.05).ROC analysis found that the AUC values of Ktrans,Ve,f,ADC,Cho/Cr,Cho/NAA alone and in combination were 0.688,0.821,0.835,0.679,0.801,0.785 and 0.988.The AUC of combined diagnosis was the largest,and the sensitivity and specificity in the differential diagnosis of postoperative recurrence and PP were 95.32%and of 93.07%.Conclusion The combined use of DCEMRI,IVIM-DWI and MRS is very helpful for differential diagnosis of postoperative recurrence and PP of glioma,and can provide reliable guidance for clinical practice.