磁共振灌注加权成像与扩散张量成像在脑胶质瘤分级诊断中的应用  

The application of magnetic resonance diffusion tensor and perfusion-weighted imaging in grading of cerebral giiomas

作　　者：江晶晶[1] 谈晓飞 张顺[1] 张妍[1] 姚义好[1] 覃媛媛[1] 郭东生[1] 赵凌云[1] 朱文珍[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《中华实验外科杂志》2014年第7期1585-1587,共3页Chinese Journal of Experimental Surgery

基　　金：国家“十二五”科技支撑计划资助项目（2011BA108BIO）;国家自然科学基金资助项目（30870702）;湖北省自然科学基金资助项目（2010CDA034）

摘　　要：目的 探讨磁共振灌注加权成像（PWI）与扩散张量成像（DTI）在脑胶质瘤分级诊断中的应用价值。方法 分析我院经手术病理学证实的45例脑胶质瘤（低级别22例,高级别23例）。测量平均扩散系数（ADC）、各向异性分数（FA）、相对平均扩散系数（rADC）、相对各向异性分数（rFA）、局部脑血流量（rCBF）、局部脑血容量（rCBV）、相对局部脑血流量（rrCBF）、相对局部脑血容量（rrCBV）值,应用统计学方法对肿瘤不同部位以及高低级别胶质瘤间各个指标进行差异性比较,并根据受试者操作特征（ROC）曲线确定诊断阈值和分析其敏感度及特异度。结果 45例脑胶质瘤瘤体的ADC、rCBF、rCBV值分别大于相应瘤周、大于相应对侧白质的测量值,FA瘤体〈FA瘤周〈FA对侧白质。各量化指标之间差异均有统计学意义（P〈0.05）,高级别胶质瘤瘤体及瘤周的rrCBV、rrCBF分别大于低级别胶质瘤（P〈0.01）,高级别胶质瘤瘤体的rADC值小于低级别胶质瘤（P〈0.01）,根据ROC曲线分析,rrCBF和rrCBV的诊断阈值分别为2.749和3.058,相应的分级诊断的敏感度和特异度分别为87%、100%与91.3%、95.5%,瘤体rADC及rFA值无诊断价值。结论脑胶质瘤的瘤体rCBF、rCBV及ADC值,可以用于胶质瘤术前分级诊断,其中,rrCBF的诊断敏感度和特异度高,rrCBF的ROC曲线下面积最大。Objective To study the application of magnetic resonance （MR） , perfusion-weighted imaging （PWI） and diffusion tensor imaging （DTI） in grading gliomas. Methods 45 patients with in- tracranial gliomas （22 low-grade and 23 high-grade gliomas） were performed with MR examination, inclu ding conventional magnetic resonance imaging （MRI）, diffusion tensor imaging （DTI） and perfusion weighted imaging （PWI）. Quantitative parameters average cerebral coefficient（ADC）, fractional anisotropy（ FA）, reginal cerebral blood flowr（CBF） , reginal cerebral blood volume （rCBV） of solid regions of tumors, peritumoral regions and analogous locations in the contralateral WM corresponding to the tumor were measured on corresponding parameter maps generated from DTI or PWI. Then these values were com pared between different groups. Receiver operating characteristic （ROC） analyses were performed to deter mine optimum thresholds for grading and also to calculate the sensitivity and specificity for tumor grading. Results There was a strong correlation between rCBF and rCBV of the solid regions in all 45 cases （R2 = 0. 9388, P 〈 0. 01）. There was statistical significances between the ADC, FA, rCBF, rCBV values of solid regions, peritumoral region and normal white matter values （ P 〈 0. 05 ）. The difference of relative rCBV （rrCBF） and relative ADC （rADC） of solid region between high and low grade gliomas was statistical （P 〈 0.01 ）. So was that of the rrCBV of peritumoral regions （ P 〈 0. 01 ）. The threshold of rrCBF, rrCBV, of solid region were 2. 749 and 3. 058, respectively, and the diagnostic sensibility and specificity were 87% and 100% vs. 91.3% and 95.5% , respectively. All rrCBF, rrCBV, ADC values of solid region showed high diagnostic accuracy. Conclusion The rrCBF, rrCBV, ADC values of solid region of tumors can be used to differentiate high and low grade gliomas. The diagnostic sensitivity and specificity of rrCBF are high. and the area under the ROC

关 键 词：脑胶质瘤 磁共振成像 扩散张量成像 灌注加权成像 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]