3D-PcASL和SWI在鉴别胶质瘤术后复发和假性进展中的价值

The Value of 3D-PCASL and SWI in Differentiating Postoperative Recurrence and Pseudoprogression of Glioma

目的:分析三维伪连续式动脉自旋标记(3D-PcASL)和磁敏感加权成像(SWI)在鉴别原发性胶质瘤复发和假性进展中的诊断价值。材料与方法:纳入37例术后并放疗后出现新发强化灶的患者,采用二次手术或参考RANO标准进行3~6个月纵向MRI随访用于明确诊断。计算病灶强化区域的最大脑血流量(rCBFmax)、出血灶与强化区域面积占比(proSWI),分析两组间rCBF和proSWI值的统计学差异并评估两参数间的相关性,ROC曲线分析评价诊断性能并确定截断值。结果:复发组proSWI均值显著低于假性进展组(0.070 vs 0.270;p 【0.001),rCBFmax显著高于假性进展组(2.189 vs 1.258;p 【0.001),AUC可达到0.856、0.869,联合二个评价参数诊断,AUC可以达到0.944。proSWI与rCBF值呈负相关。结论:proSWI和rCBF值是鉴别胶质瘤复发和假性进展的可靠参数,ASL和SWI联合成像可以提高鉴别诊断的能力。

Objective: To assess and compare the diagnostic performance of 3D pseudo-continuous arterial spin labeling (3D-PcASL) imaging and susceptibility-weighted imaging (SWI) in distinguishing tumor recurrence from pseudo-progression in post-treatment glioma patients. Materials and Methods: The study enrolled 37 patients who underwent resection and chemoradiation for pathologically verified gliomas with new enhancing lesions. They underwent magnetic resonance imaging (MRI) examination that included conventional MRI sequences, SWI and 3D-PcASL sequences. Longitudinal MRI for 3~6 months follow-up or repeat surgery was used to define the diagnosis. We calculated the proportion of hemorrhagic foci for the enhancing lesions (proSWI) on magnitude image of SWI. The CBF was obtained from ASL and compared with the contralateral normal gray matter. Further comparison will use student’s t-test or Mann-Whitney U test to evaluate parameter performance and receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of the parameters. Results: The proSWI in tumor recurrence group was significantly lower than in the pseudo-progression (0.070 vs 0.270;p <0.001) and rCBF was significantly higher in the tumor recurrence group (2.189 vs 1.258;p <0.001), with the area under the ROC curve (AUCs) of 0.856 and 0.869. By adding proSWI to rCBF values, AUC can reach 0.944. The proSWI was negatively correlated with the rCBF. Conclusion: proSWI and rCBF are both valuable and complementary parameters in differentiating tumor recurrence from pseudo-progression. The combination of SWI and ASL imaging has the potential to improve diagnostic performance.