体素内不相干运动扩散加权成像和三维动脉自旋标记成像评估脑胶质瘤Ki-67标记指数和分级的价值  

Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging and three-dimensional arterial spin labeling in Ki-67 labeling index and grading of brain gliomas

作　　者：王超超 董海波[2] 丁方[3] 李亚迪[2] 王高燕[2] 丁华新[4] Wang Chaochao;Dong Haibo;Ding Fang;Li Yadi;Wang Gaoyan;Ding Huaxin(Ningbo University School of Medicine,Ningbo 315211,China;Department of Radiology,Li Huili Hospital, Ningbo Medical Center,Ningbo 315040,China;Department of Neurosurgery,Li Huili Hospital,Ningbo Medical Center,Ningbo 315040,China;Department of Pathology,Li Huili Hospital,Ningbo Medical Center, Ningbo 315040,China)

机构地区：[1]宁波大学医学院,宁波315211 [2]宁波市医疗中心李惠利医院放射科,宁波315040 [3]宁波市医疗中心李惠利医院神经外科,宁波315040 [4]宁波市医疗中心李惠利医院病理科,宁波315040

出　　处：《中华医学杂志》2019年第5期338-342,共5页National Medical Journal of China

基　　金：浙江省医药卫生科技项目(2017KY572);宁波市科技惠民项目(2016C51017).

摘　　要：目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)和三维动脉自旋标记(3D-ASL)评估脑胶质瘤Ki-67标记指数(Ki-67LI)和分级的价值。方法回顾性分析2015年12月至2018年5月宁波市医疗中心李惠利医院经手术病理证实的45例脑胶质瘤患者,男24例、女21例,年龄25-83(53±12)岁,分为低级别组(WHOⅡ级20例)和高级别组(WHOⅢ级12例、WHOⅣ级13例),经免疫组化获得胶质瘤的Ki-67LI。患者术前均行颅脑MRI常规扫描、IVIM-DWI和3D-ASL检查,测量肿瘤最大层面实性区域和对侧正常白质区域的真性水分子扩散系数(D)、微循环灌注系数(D*)、灌注分数(f)和脑血流量(CBF)。利用秩和检验(Mann-WhitneyU检验)比较高、低级别组间4个定量参数、Ki-67LI的差异。采用Spearman法分析4组定量参数与Ki-67LI之间相关性。采用受试者工作特征(ROC)曲线评估4组定量参数在脑胶质瘤分级的诊断效能。结果高级别组D值(0.791×10^-3mm^2/s)、f值(0.261)均低于低级别组,D*值(4.153×10^-3mm^2/s)、CBF值(102.027ml·min^-1·100g^-1)及Ki-67LI(0.25)均高于低级别胶质瘤,差异均有统计学意义(均P<0.05)。D、f与Ki-67LI呈中度负相关,相关系数r分别为-0.513、-0.457(均P<0.05);D*与Ki-67LI无明显相关性(P=0.571)。D、D*、f和CBF鉴别高、低级别胶质瘤的曲线下面积(AUC)分别为0.965、0.745、0.842和0.830,均P<0.05。结论D、f值可定量预测Ki-67LI,IVIM-DWI和3D-ASL有助于脑胶质瘤的分级评估,D值诊断效能最高。Objective To investigate the value of multiple parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional arterial spin labeling (3D-ASL) in Ki-67 labeling index (Ki-67 LI) and grading of human brain gliomas. Methods From December 2015 to May 2018, 45 patients of gliomas confirmed by surgical pathology in Li Huili Hospital, Ningbo Medical Center were divided into low-grade group (20 cases of WHO grade Ⅱ) and high-grade group (12 cases of WHO grade Ⅲ, 13 cases of WHO grade Ⅳ), and the Ki-67 LI of glioma was obtained by immunohistochemistry. All patients, 24 males and 21 females, aged 25-83 years, mean(53±12)years, underwent conventional magnetic resonance imaging (MRI), IVIM-DWI and 3D-ASL before operation, then measured the true water diffusion coefficient (D), microcirculation perfusion coefficient (D*), perfusion fraction (f) and cerebral blood flow (CBF) in the tumor solid area and the contralateral normal white matter area. Those parameters and the Ki-67 LI were compared between the low-and high-grade groups with Mann-Whitney U test. Spearman′s correlation was used to analyze the correlation between the quantitative parameters and Ki-67 LI. The ROC curve was used to assess the diagnostic efficacy of parameters in the grading assessment of brain gliomas. Results The D(0.791×10^-3mm^2/s) and f (0.261) of the high-grade group were lower than those of the low-grade group, whereas D* (4.153×10^-3 mm^2/s), CBF(102.027 ml·min^-1·100 g^-1) and Ki-67 LI (0.25) were higher (P<0.05). There was a moderate negative correlation between D, f and Ki-67 LI(r=-0.513,-0.457, all P<0.05). There was no significant correlation between D* and Ki-67 LI (P=0.571). The area under the curve (AUC) for identifying high-and low-grade gliomas by D, D*, f and CBF values was 0.965, 0.745, 0.842, and 0.830 respectively (all P<0.05). Conclusion D and f can be used for quantitative prediction of Ki-67 LI. IVIM-DWI and 3D-ASL are helpful in the grading assessment of gliomas, and

关 键 词：磁共振成像 神经胶质瘤 自旋标记物 KI-67抗原 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]