磁敏感加权成像与动态磁敏感加权对比增强MR灌注加权成像联合应用在脑星形细胞瘤分级中的价值  

Combined value of susceptibility weighted imaging and dynamic susceptibility-weighted contrast- enhanced MR perfusion-weighted imaging in brain astrocytoma grading

作　　者：王效春[1] 张辉[1] 秦江波[1] 王乐[1] 吴晓峰[1] 

机构地区：[1]山西医科大学第一临床医学院影像科,太原030001

出　　处：《中华放射学杂志》2012年第11期988-992,共5页Chinese Journal of Radiology

基　　金：山西省科技攻关项目（20080322024）

摘　　要：目的探讨磁敏感加权成像（SWI）与动态磁敏感加权对比增强（DSC）MR灌注加权成像联合应用在脑星形细胞瘤分级诊断中的价值。方法82例经手术病理证实的脑星形细胞瘤患者行SWI与DSCMR灌注加权成像扫描，低级别星形细胞瘤15例（WHOⅡ级），间变性星形细胞瘤10例（WHOⅢ级），胶质母细胞瘤57例（WHOⅣ级）。评价肿瘤内磁敏感信号（ITSS）与相对脑血容量（rCBV）最大值，应用Kruska／Wallis检验、Welch检验、Spearman相关系数、Pearson相关性分析和受试者工作特征曲线分析ITSS和rCBV单独使用和两者联合应用对星形细胞瘤分级的效能。结果低级别星形细胞瘤14例未见到ITSS，间变性星形细胞瘤ITSS分级为1-3级，胶质母细胞瘤ITSS分级均为3级，3组间差异有统计学意义（H=71．96，P〈0．01）。Ⅱ、Ⅲ和Ⅳ级星形细胞肿瘤内rCBV最大值分别是1．26±0．42、3．59＋2．09和8．34＋1．16，3组间差异有统计学意义（F’=681．72，P〈0．01）。肿瘤内ITSS与rCBV最大值和病理分级呈正相关（r值分别为0．72、0．89，P值均〈0．01），rCBV与病理分级呈正相关（r=0．78，P〈0．01）。SWI、DSC及SWI与DSC联合应用鉴别Ⅱ和Ⅲ级星形细胞瘤ROC曲线下面积分别是0．99、0．93、1．00，鉴别Ⅲ和Ⅳ级星形细胞瘤ROC曲线下面积分别是0．70、0．94、0．94，鉴别高低级别星形细胞瘤ROC曲线下面积分别是1．00、0．99、1．00。结论脑星形细胞瘤ITSS可以对脑星形细胞瘤进行分级，SWI与DSC联合应用可以提高脑星形细胞瘤分级的准确性。Objective To assess the value of combination of susceptibility weighted imaging （SWI） and dynamic susceptibility-weighted contrast-enhanced （DSC） perfusion-weighted magnetic resonance imaging in astrocytoma grading. Methods SWI and DSC scans were performed in 82 patients with pathologically confirmed astrocytoma. The patient group consisted of grade Ⅱ （15）, grade Ⅲ （10）, and grade Ⅳ （57）. The intratumoral susceptibility signal intensity （ITSS） and relative cerebral blood volume （rCBV） max were used to determine the grade of astrocytomas by Kruskal Wallis test, Welch test, Spearman correlation coefficients, Pearson correlation coefficients, and receiver operating characteristic curve （ROC） statistic methods. Results There were no ITSS in 14 cases of low-grade astrocytomas, the degree of ITSS were grade 1 to 3 in anaplastic astrocytomas, the degree of ITSS were grade 3 in all of the glioblastomas, the degree of ITSS were significant difference in all grades （ H = 71.96, P 〈 0. 01 ）. rCBV max in grade Ⅱ, gradeⅢ and grade IV astrocytomas were 1.26 ± 0. 42,3.59 ± 2.09 and 8.34 ± 1.16 respectively, rCBV max were significant difference in all grades （ F＇ = 681.72, P 〈 0. 01 ）. ITSS showed significant correlation with rCBV max （ r = 0. 72, P 〈 0. 01 ） and tumor grades （ r = 0. 89, P 〈 0.01 ）, and rCBV and tumor gradesshowed significant correlation （ r = 0. 78, P 〈 0.01 ）. Area under the ROC curve application SWI, DSC, SWI and DSC in differentiation of the grade Ⅱ and grade Ⅲ astrocytomas were 0. 99,0. 93, 1.00, differentiate gradeⅢ from grade Ⅳ were 0.70, 0.94, 0. 94, and differentiate high-grade from low-grade astrocytomas were 1.00, 0. 99, 1.00. Conclusions ITSS is helpful to determine the grade of astrocytomas. The use of SWI in combination with DSC may improve the diagnostic accuracy of astroeytoma grading.

关 键 词：星形细胞瘤 磁共振成像 灌流 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学]