磁共振功能成像鉴别高级别胶质瘤术后室管膜下区受累的临床意义研究

Clinical significance of functional magnetic resonance imaging in identifying subventricular zone involvement in postoperative patients with high-grade gliomas

目的探索高级别胶质瘤(HGG)术后磁共振功能成像影像学特点与室管膜下区(SVZ)受累的关系.方法回顾性分析2018-01-01-2020-06-30江苏省肿瘤医院收治的50例HGG患者,男28例,女22例;年龄22~73岁,中位年龄53岁.入组患者均于放疗前行MRI功能成像扫描,总结HGG患者术后常规MRI和功能MRI的影像学特点并分析其与SVZ受累的关系.采用Fisher确切概率检验分析SVZ受累的关系,logistic回归模型进行单因素和多因素分析.结果SVZ受累共40例(80.0%),高灌注改变26例(52.0%),瘤周纤维束断裂和缺失39例(78.0%).术区T1强化40例,其中15例(37.5%)存在高灌注区域,35例(87.5%)SVZ受累.术区T1强化患者的SVZ受累表现高于无术区强化患者(87.5%vs 50.0%,P=0.018),术区高灌注患者的SVZ受累表现高于术区无高灌注患者(40.0%vs 0,P=0.020),术区周围纤维束断裂患者的SVZ受累表现高于术区周围无纤维束断裂患者(90.0%vs 30.0%,P=0.004).多因素分析结果显示,术区周围纤维束断裂或缺失和手术区强化是SVZ受累的危险因素,均P<0.05.结论HGG影像学特征表现为术区T1强化、术区高灌注和术区周围纤维束断裂或缺失患者的SVZ受累表现更高.术区周围纤维束断裂或缺失、术区T1增强是SVZ受累的危险因素.

Objective To investigate the relationship between postoperative magnetic resonance functional imaging charac-teristics and the involvement of the subventricular zone(SVZ)in high-grade glioma(HGG).Methods Retrospective a-nalysis of 50 patients with HGG admitted to Jiangsu Provincial Cancer Hospital from 2018-01-01-2020-06-30,including 28 males and 22 females;age 22-73 years old,median age 53 years old.All enrolled patients underwent MRI functional imaging scans before radiotherapy,and the postoperative conventional MRI and functional MRI imaging of HGG patients were summarized.Imaging features of the patients were analyzed,with a specific focus on their correlation with SVZ in-volvement.Fisher's exact probability test was used to analyze the relationship between SVZ involvement,and logistic re-gression models were used for univariate and multivariate analysis.Results Among the 50 HGG patients included in the study,SVZ involvement was observed in 40 cases(80.0%),high perfusion changes in 26 cases(52.0%),and disruption or absence of peritumoral fiber tracts in 39 cases(78.0%).In the patients with surgical area T1 enhancement,15 cases(37.5%)had high perfusion areas,and 35 cases(87.5%)showed SVZ involvement.The presence of SVZ involvement in the surgical area of patients with T1 enhancement was significantly higher than in the patients without surgical area en-hancement(87.5%vs 50.0%,P=0.018).The incidence of SVZ involvement in the surgical area of patients with high perfusion was significantly higher than that in the patients without high perfusion(40.0%vs 0,P=0.020).The pres-ence of SVZ involvement in the surgical area of patients with disrupted peritumoral fiber tracts was significantly higher than that in the patients without fiber tract disruption(90.0%vs 30.0%,P=0.004).Multivariate analysis showed that disruption or absence of peritumoral fiber tracts and enhancement of the surgical area were risk factors for SVZ involve-ment(P<0.05).Conclusions HGG imaging characteristics,such as enhancement of the surgical area,high perfusion within the surgical area,and disruption or absence of peritumoral fiber tracts,are associated with higher incidence of SVZ involvement.Disruption or absence of peritumoral fiber tracts and T1 enhancement of the surgical area are risk factors for SVZ involvement.