应用DWI和DTI勾画高级别胶质瘤术后放疗靶区的初步研究  

Primary study of DWI and DTI in delineation of radiotherapy target volume with post-operative high-grade glioma

作　　者：倪春霞[1] 汪洋[1] 盛晓芳[1] 孟歌[1] 陈淑[1] 于同刚[2] 丁建[2] 江华[2] 戴嘉中[2] 潘力[3] 

机构地区：[1]复旦大学附属华山医院上海伽玛医院肿瘤放疗中心 [2]复旦大学附属华山医院放射科 [3]复旦大学附属华山医院神经外科

出　　处：《临床神经外科杂志》2015年第3期223-226,共4页Journal of Clinical Neurosurgery

基　　金：上海市卫计委科研课题(20134438)

摘　　要：目的初步探讨MRI弥散加权成像（DWI）和弥散张量成像（DTI）在高级别胶质瘤（HGG）术后放疗靶区勾画中的应用价值。方法对复旦大学附属华山医院上海伽玛医院收治的HGG术后残留患者做前瞻性研究。所有患者放疗前行DWI和DTI检查,在ADC图和FA图上分别测量残留肿瘤、肿瘤外1 cm区域内（定义为近瘤周区）、1-2 cm区域内（定义为中瘤周区）、2-3 cm区域内（定义为远瘤周区）及3-4 cm区域内（定义为瘤周区外）和对侧正常脑组织的ADC平均值、ADC最小值、FA平均值和FA最小值。结果 2013年9月至2014年8月,共有55例HGG患者入组,ADC平均值和最小值呈现从残留肿瘤、近瘤周区到中瘤周区逐渐升高的趋势,并从中瘤周区、远瘤周区到瘤周区外逐渐降低;其中,残留肿瘤与近瘤周区,以及中瘤周区与远瘤周区、远瘤周区与瘤周区外比较,差异均有统计学意义（均P〈0.05）;FA平均值和最小值呈现从残留肿瘤、近瘤周区、中瘤周区、远瘤周区到瘤周区外逐渐升高的趋势,但各区差别无统计学意义（均P〉0.05）。结论本研究初步显示DWI技术可能有助于术后HGG及肿瘤周边组织性质的确定,指导HGG术后放疗靶区的勾画;FA值对于靶区勾画的价值有待进一步研究。Objective To explore the values of diffusion-weighted image （ DWI ） and diffusion-tensor imaging（DTI） in the delineation of radiotherapy target volume for patients with post -operative high-grade glioma .Methods The postoperative high-grade glioma （ HGG） patient with residual tumor was included in this prospective study . All patients were performed DWI and DTI MRI pre-radiotherapy .The average and minimum values of apparent diffusion coefficient （ ADC） and fractional anisotropy（FA） were measured in residual tumor , peritumoral tissue and the corresponding normal tissue.The peritumoral tissue is divided into four areas：1cm distance from tumor margin （defined as the proximal area ）;1-2 cm distance from tumor margin （ defined as the middle area ）;2-3 cm distance from tumor margin （ defined as the distal area ） ;3-4 cm distance from tumor margin （ defined as the outside area）.Results From Sep.2013 to Aug.2014, 55 patients were included .The average and minimum ADC values are increased from the residual tumor to the middle area , which are statistically significant;and then the values become decreased from middle area to outside area , although the difference was not significant .The average and minimum FA values are gradually increased , but no significant difference was found .Couclusion DWI could help define the nature of residual tumor and peritumoral tissue , which could present valuable information for target delineation for high-grade glioma after operation .The value of FA need further study .

关 键 词：胶质瘤 弥散加权成像 弥散张量成像 放射治疗 

分 类 号：R739.41[医药卫生—肿瘤]