磁共振FSE/MDME序列联合DWI预测胶质瘤病理组织学分级及增殖活性的研究

Prediction of histopathological grade and proliferative activity of glioma by FSE/MDME sequence combined with DWI

目的:探讨快速自旋回波(FSE)/多延迟饱和多回波(MDME)联合弥散加权成像(diffusion-weighted imaging,DWI)预测胶质瘤病理组织学分级,并进一步分析与增殖活性的关系,旨在为早期识别高级别及高增殖活性人群提供更多有价值信息。方法:回顾性纳入2018年01月至2023年01月于我院行手术治疗并经病理组织学检查证实为胶质瘤患者137例,根据病理组织学分级情况分为高级别组(82例)和低级别组(55例);比较两组基线临床资料及磁共振影像学定量分析指标,FSE/MDME联合DWI磁共振用于胶质瘤病理组织学分级预测临床效能分析。结果:两组基线临床资料比较差异无统计学意义(P>0.05);低级别组T1值和质子密度均显著低于高级别组(P<0.05);低级别组表观弥散系数显著高于高级别组(P<0.05);两组T2值比较差异无统计学意义(P>0.05)。T1值、质子密度及表观弥散系数均可用于胶质瘤病理组织学分级预测,单一指标中表观弥散系数预测AUC显著高于T1值及质子密度,同时三者联合预测效能优于三者单用(P<0.05)。胶质瘤患者表观弥散系数与Ki-67阳性细胞比例呈负相关,而T1值和质子密度与Ki-67阳性细胞比例呈正相关(P<0.05),但T2值则与Ki-67阳性细胞比例无相关性(P>0.05)。结论:FSE/MDME联合DWI磁共振可用于胶质瘤病理组织学分级预测,且T1值、质子密度及表观弥散系数三者联合预测效能最佳;同时上述磁共振定量分析指标与胶质瘤组织细胞增殖活性有关。

Objective:To construct the clinical efficacy of FSE/MDME combined with DWI magnetic resonance in predicting of histopathological grade and relationship with proliferative activity of glioma to provides more reference for early identification of high grade and high proliferative population.Methods:137 patients with glioma confirmed by histopathological examination after surgery were retrospectively chosen in the period from January 2018 to January 2023 in our hospital and grouped into high grade group(82 cases) and low grade group(55 cases) according to histopathological grade.The baseline clinical data and quantitative analysis of magnetic resonance imaging of 2 groups were compared.FSE/MDME combined with DWI magnetic resonance was used to predict the clinical efficacy of glioma histopathological grade.Results:There was no significant difference in baseline clinical data between 2 groups(P>0.05).The T1 value and proton density of low grade group were significantly lower than high grade group(P<0.05).The apparent dispersion coefficient of low grade group was significantly higher than high grade group(P<0.05).There was no significant difference in T2 values between 2 groups(P>0.05).T1 value,proton density and apparent dispersion coefficient can be used to predict the grade of glioma histology.The apparent dispersion coefficient of single index is significantly higher than T1 value and proton density in of single index is significantly higher than T1 value and proton density in predicting AUC,and the combined prediction efficiency of the three indexes is better than that of the three indexes alone( P < 0.05).The apparent diffusion coefficient of glioma patients was negatively correlated with the proportion of Ki-67 positive cells,while T1 and proton density were positively correlated with the proportion of Ki-67 positive cells( P < 0.05).However,there was no correlation between T2 and Ki-67 positive cells( P > 0.05).Conclusion:FSE/MDME combined with DWI magnetic resonance can be used to predict the pathological grade of glioma,and the combination of T1 value,proton density and apparent dispersion coefficient is the best predictor.At the same time,the above quantitative magnetic resonance analysis indexes were related to the proliferation activity of glioma histocyte.