以T_2-FLAIR为参照测量ADC值对胶质瘤治疗后评价的对照研究  

A Control Study About Assessment of Response in Postoperative Patients with Glioma by ADC Which is Obtained at the Hyperintense FLAIR Region

作　　者：全冠民[1] 舒彩锟 袁涛[1] 魏建海[3] 郑永利[1] 

机构地区：[1]河北医科大学第二医院影像科,石家庄050000 [2]武警重庆总队医院影像科 [3]河北省黄骅市人民医院

出　　处：《临床放射学杂志》2017年第10期1386-1391,共6页Journal of Clinical Radiology

摘　　要：目的比较以增强T_1WI(CE-T_1WI)及FLAIR序列为参照时,胶质瘤治疗后高b值DWI成像ADC值测量对在鉴别胶质瘤治疗后进展与非进展判断的差异。方法 47例连续脑胶质瘤术后放化疗患者,治疗前、后行CET_1WI、FLAIR和多b值DWI(b=1000、2000、3000 s/mm^2),分别获取两组ADC图[ADC(3000/1000),ADC(3000/2000)]。47例共59个强化+FLAIR高信号病变;按RANO标准分为进展组(27例30个病灶)与非进展组(20例29个病灶)。测量两组强化与FLAIR高信号对应区域的平均ADC值(CADC_(mean)与FADC_(mean))和最小ADC值(CADC_(min)与FADC_(min)),计算r ADC。运用两独立样本t检验及Wilcoxon秩和检验分别比较两组ADC值的差异,采用ROC曲线分析两种测量方法评价肿瘤进展的效率。结果两组ADC图中进展组平均ADC值及其相对值(两种测量方法)均低于非进展组(P<0.05)。进展组对应于CE-T_1WI和FLAIR高信号区的最小ADC值略低于非进展组,但除ADC图(3000/1000)时两组间差别具有统计学意义外(P=0.023),其余ADC图中两种测量方法的最小ADC值和其相对值无明显差别(P值均>0.05)。两种测量方法获取的ADC值在鉴别肿瘤进展的曲线下面积相近。以ADC(3000/2000)图中r CADC_(mean)与FADC_(mean)ROC曲线下面积最大,其最佳阈值、敏感性、特异性、阳性预测值和阴性预测值分别为:rCADC_(mean):1.12、92.9%、77.4%、80.4%、91.6%;FADC_(mean):487.45 mm^2/s、89.3%、83.9%、84.7%、88.8%。结论以FLAIR为参照测量ADC值能有效界定胶质瘤治疗后近期肿瘤进展与非进展,其准确性与CET_1WI参照法的方法相当,提示FLAIR序列可替代CE-T_1WI作为胶质瘤治疗后评估ADC值测量的参照。Objective The purpose of this study is to compare the distinction of different apparent diffusion coefficient （ADC） in detecting tumor progression,which is elicited from the enhancement and hyperintense FLAIR region.Methods This study enrolled 47 postoperative patients with a diagnosis of glioma.All of them received chemoradiotherapy after operation.MRI scanning was executed before and after chemoradiotherapy.MRI scanning included T1WI、FLAIR、CE-T1WI and multiple b-value DWI（b =1000、2000、3000（s/mm2）） and calculations of two groups with different ADC map[ADC （3000/1000）,ADC （3000/2000）].Forty-seven patients with 59 lesions were divided into progression （27 patients,30 lesions） and non-progression （20 patients,29 lesions） groups by the Response Assessment Neuro-Oncology （RANO） Working Group criteria.The mean and minimum ADC（CADC and FADC CADCmin and FADCmin） were obtained at different regions of interest （ROI） in corresponding ADC maps.The ROIs were reference to CE-T1 WI and FLAIR.The relative ADC was then calculated.Each ADC value between progression and non-progression groups was compared by using the unpaired Student t test or Wilcoxon rank sum test.ROC analysis was used to determine the best cutoff values for distinguishing progression from non-progression.Results The ADC values were significantly lower in the progression group than in the non-progression group either in the enhancement or hyperintense FLAIR region（P 〈 0.05）.In addition,the rFADCnin was significantly lower in the progression group than in the non-progression group in ADC （3000/1000） map（P =0.023）,the rest of the minimum ADC values had no significant differences in other ADCmaps（P 〉 0.05）.The area under the receiver operating characteristic curve（AUC） of the ADC was similar between the enhancement and hyperintense FLAIR region.When rCADC and FADC were 1.12 and 487.45 mm2/s in ADC（3000/2000）map,the sensitivity、specificity、postive predictive value and negative predictiv

关 键 词：胶质瘤 肿瘤进展 治疗 磁共振成像 弥散 表观扩散系数 

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]