多b值DWI在脑胶质瘤治疗后近期评价中的应用  

Application of multiple b-value DWI in assessment of early treatment response in postoperative patients with glioma

作　　者：舒彩锟 全冠民[1] 袁涛[1] 魏建海[2] 郑永利[1] 雷建明[1] 

机构地区：[1]河北医科大学第二医院影像科,河北石家庄050000 [2]黄骅市人民医院影像科,河北黄骅061300

出　　处：《中国医学影像技术》2017年第8期1190-1196,共7页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨应用多b值DWI中不同b值ADC值评估胶质瘤近期治疗效果及鉴别肿瘤进展的价值。方法对47例经手术病理证实为脑胶质瘤且接受联合放化疗的患者行常规MRI及多b值DWI(b=0、1 000、2 000、3 000s/mm^2)扫描。分别在5种不同b值组合(b值组合分别为:0、1 000s/mm^2,0、2 000s/mm^2,0、3 000s/mm^2,1 000、3 000s/mm^2,2 000、3 000s/mm^2)的ADC图[ADC_((1 000/0))、ADC_((/2 000/0))、ADC_((3 000/0))、ADC_((3 000/1 000))、ADC_((3 000/2 000))]中测量病灶的平均和最小ADC值(ADC_(mean)和ADCmin),计算其相对值(rADC_(mean)、rADCmin)。比较治疗后不同反应类型(完全有效、部分有效、稳定、进展)间及进展组与非进展组间ADC值的差异,通过ROC曲线分析不同ADC值诊断肿瘤进展的最佳临界值和诊断效能。结果 ADC_((3 000/0))、ADC_((3 000/1 000))和ADC_((3 000/2 000))图中的rADC_(mean)在不同反应类型间和进展组与非进展组间差异均有统计学意义(P均<0.05);ADC_((3 000/1 000))和ADC_((3 000/2 000))图中的ADC_(mean)在不同反应类型间和进展组与非进展组间差异均有统计学意义(P均<0.05)。ADC_((3 000/2 000))图中ADC_(mean)和rADC_(mean)诊断肿瘤进展的曲线下面积最大,分别为0.86和0.84,以ADC_(mean)=408.65×10^(-6)mm^2/s和rADC_(mean)=1.12诊断胶质瘤进展的敏感度、特异度分别为89.3%、71.0%和92.9%、77.4%。结论通过高b值ADC图中病灶的ADC_(mean)和rADC_(mean)可较准确地评估胶质瘤的近期治疗效果,并为鉴别胶质瘤术后肿瘤进展提供有价值的信息。Objective To evaluate the application value of ADC of different b-value ADC maps in multiple b-value DWI for assessment of early treatment response and detection of tumor progression.Methods Totally 47 postoperative patients with glioma were enrolled.All of them accepted chemoradiotherapy after operation.Conventional MRI and multiple b-value DWI（b=0,1 000,2 000,3 000s/mm2）scans were performed.The mean and minimal ADC values（ADC（mean）and ADCmin）were measured in 5 differrent corresponding ADC maps,such as ADC（（1 000/0））,ADC（（/2 000/0））,ADC（（3 000/0））,ADC（（3 000/1 000））and ADC（（3 000/2 000））.And the relative values（rADC（mean）and rADCmin）were calculated.The differences of ADC values among different reaction types（complete response,partial response,stable disease and progressive disease）and between progressive and non-progressive groups were compared.ROC analysis was used to determine the best cutoff values and diagnostic efficiency of ADC value for diagnosis of tumor progression.Results The rADC（mean）in ADC（（3 000/0））,ADC（（3 000/1 000））and ADC（（3 000/2 000））maps were significantly different among different response types and between progressive group and non-progressive group（all P〈0.05）.The ADC（mean）in ADC（（3 000/1 000））and ADC（（3 000/2 000））maps were significantly different among different response types and between progressive group and non-progressive group（all P〈0.05）.The ADC（mean）and rADC（mean）in ADC（（3 000/2 000））map had the maximum area under curve（0.86,0.84）.When ADC-meanand rADC（mean）in ADC（（3 000/2 000））map were 408.65×10^（-6） mm2/s and 1.12,the sensitivities and specificities were 89.3%,71.0% and 92.9%,77.4%,respectively.Conclusion The ADC（mean）and rADC（mean）in high b-value ADC maps are helpful to discriminate the early treatment response from tumor progression,which can provide valuable information for identification of tumor progression

关 键 词：胶质瘤 治疗 扩散磁共振成像 表观扩散系数 肿瘤进展 

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