基于DCE定量和半定量参数分析胶质母细胞瘤环壁强化类型与炎症的相关性研究

The Correlation Between the Enhancement Type of GBM Ring Wall and Inflammation was Analyzed Based on DCE Quantitative and Semi-Quantitative Parameters

目的 利用动态对比增强(DCE)定量与半定量分析方法探究胶质母细胞瘤(GBM)的环壁强化类型与坏死相关炎症的关系。方法 回顾性分析2015年9月至2020年9月经病理证实且呈环形强化的GBM 23例和炎性病灶17例,GBM的瘤壁均由厚而不规则的毛玻璃样强化和薄而光滑的显著薄壁强化两种类型组成。所有患者均在术前2周内行3.0 T MRI常规平扫、T_1WI增强扫描和DCE序列扫描。利用美国GE Omni-Kinetics Version软件在DCE图像上手动勾画肿瘤和炎性病变最大层面环壁的感兴趣区(ROI),比较GBM的厚壁毛玻璃样强化(1组)、薄壁显著强化(2组)和炎性病变环形强化(3组)的DCE参数,包括容积转运常数(K^(trans))、血管外细胞外容积分数(V_(e))、曲线下面积(AUC)、速率常数(K_(ep))、血浆容积分数(V_(p))、达峰时间(TTP)、最大斜率(MAXslope)的差异。其中K^(trans)、AUC和V_(p)的比较用方差分析和最小显著差法(LSD);K_(ep),TTP,MAXslope比较用秩和检验及Kruskal-Wallis检验。结果 三组环壁强化类型比较,K^(trans)、AUC及MAXslope的差异具有统计学意义(P<0.05)。GBM的厚壁毛玻璃样强化区的K^(trans)、AUC、MAXslope均高于薄壁显著强化区和炎性病变,后两者的K^(trans)、AUC、MAXslope均无显著统计学差异(P>0.05)。结论 GBM的薄壁显著强化区与炎性病变具有相似的血流动力学和渗透性特征,推测GBM薄壁显著强化区可能存在炎性过程的参与。

Objective This study aimed to explore the correlation between ring wall enhancement types of Glioblastoma and inflammation by quantitative and semi-quantitative analysis of dynamic contrast enhancement. Methods Twenty-three GBM patients and seventeen Inflammatory lesion patients(eleven brain abscess and six tuberculomas),who confirmed by pathology, were retrospectively analyzed between September 2015 and September 2020.The tumor wall of GBM was composed of two types: thick and irregular ground glass enhancement and thin and smooth thin wall enhancement. For inclusion in this study, patients need to have undergone a chest 3.0 T MRI examination within 2 weeks before surgery. MRI examination include T_1-weighted MRI,T_2-weighted MRI,T_1 enhancement MRI and DCE. The region of interest(ROI) of the largest layer of tumor and inflammatory lesions was manually delineated on DCE images using GE Omni-Kinetics Version software. The DCE parameters of thick wall ground-glass enhancement pattern(group 1),thin wall enhancement pattern(group 2) and inflammatory lesion ring enhancement pattern(group 3) were compared. Including the difference of volume transfer constant(K^(trans)),volume of the extracellular space(V_(e)),area under curve(AUC),back flux Constant(K_(ep)),plasma volume fraction(V_(p)),time to peak(TTP) and maximum rise slope(MAXslope).K^(trans),AUC and V_(p) were compared between the three groups with use of the variance analysis and least significant difference(LSD).V_(e),K_(ep),TTP and MAXslope were compared between the three groups with use of the rank sum test and Kruskal-Wallis test. Results There were significant differences in K^(trans),AUC and MAXslope among the three groups(P< 0.05).The K^(trans),AUC,and MAXslope of the thick-walled ground-glass enhancement area of GBM were higher than those of the thin-walled enhancement area and the ring-wall enhancement of inflammatory lesions. There were no significant differences in K^(trans),AUC and MAXslope of the latter two areas(P> 0.05). Conclusion The thin-walled enhancement area of GBM has similar hemodynamic and permeability characteristics to the circumferential wall enhancement area of inflammatory lesions, and it is speculated that the inflammatory process may be involved in the thin-walled enhancement area of GBM.