3D-ASL技术联合DWI在鉴别脑胶质瘤术后复发与假性进展中的应用价值  

3D-ASL and DWI in the Differential Diagnosis of Recurrent Glioma and Pseudo Progression

作　　者：潘锋[1] 吴晓[1] 苏中周 沈伟强[1] 周林江 PAN Feng;Wu Xiao;Su Zhongzhou(Department of Radiology,Huzhou Central Hospital,Zhejiang 313000,P.R.China)

机构地区：[1]浙江省湖州市中心医院放射科,313000 [2]浙江省湖州市中心医院神经外科,313000 [3]复旦大学附属华山医院放射科

出　　处：《临床放射学杂志》2018年第6期904-908,共5页Journal of Clinical Radiology

基　　金：湖州市科技局基金项目(编号:2015GYB05)

摘　　要：目的探讨3D动脉自旋标记（3D-ASL）技术联合扩散加权成像（DWI）在鉴别高级别脑胶质瘤（HGG）术后复发与假性进展中的价值。方法回顾性分析32例HGG术后放、化疗过程中或后（1-9个月不等）,MRI检查出现异常强化病灶或病灶范围扩大的患者,其中经二次手术或随访确诊肿瘤复发19例为A组,假性进展13例为B组;均行常规磁共振扫描及3D-ASL、DWI检查,分别测量强化病灶中心区、强化病灶边缘区及对侧镜像区的脑血流量（CBF）值及表观扩散系数（ADC）值,数据标准化后采用相对平均脑血流量（r CBF）、相对平均表观扩散系数（r ADC）比值行组间统计学分析。结果 r CBF值在A、B两组病灶中心区分别为3.73±0.54和0.90±0.19,t=50.20;边缘区分别为1.52±0.35和0.97±0.27,t=13.25,组间差异均有统计学意义（P〈0.05）。r ADC值在A、B组病灶中心区分别为0.71±0.21和1.74±0.35,t=26.33;边缘区分别为0.86±0.23和1.21±0.27,t=10.60,组间差异均有统计学意义（P〈0.05）。结论 3D-ASL技术联合DWI安全无创,无需注射对比剂,可准确鉴别HGG术后复发与假性进展,具有良好的应用前景。Objective To investigate the value of 3 D-ASL and DWI in the differential diagnosis of High-grade brain glioma recurrence and pseudo progression. Methods Retrospective analysis of 32 cases of HGG after radiotherapy,chemotherapy or after（ 1 - 9 months）,MRI examination of abnormal enhanced focus or enlargement of the scope of the lesion,of which 19 cases of tumor recurrence confirmed by two operations or follow-up were group A and 13 cases of false progression were group B,and routine magnetic resonance scanning and 3 D ASL,DWI examination were performed. The value of cerebral blood flow（ CBF） and apparent diffusion coefficient（ ADC） were measured in the central region of the focus,the edge of the focus and the contralateral mirror area,and the values of apparent diffusion coefficient（ ADC） were measured,and the relative mean cerebral blood flow（ r CBF） and the relative average apparent diffusion coefficient（ r ADC） ratio were statistically analyzed. Results The value of r CBF in the AB two group of the central area of the lesion were 3. 73 ＋ 0. 54 and 0. 90 ＋ 0. 19,t = 50. 20; marginal zone were 1. 52 ＋ 0. 35 and 0. 97 ＋ 0. 27,t = 13. 25,differences between groups were statistically significant（ P 〈 0. 05）.the value of r ADC in the central area of lesions in AB group were 0. 71 ＋ 0. 21 and 1. 74 ＋ 0. 35. t = 26. 33; marginal zone were 0. 86 ＋ 0. 23 and 1. 21 ＋ 0. 27,t = 10. 60,differences between groups were statistically significant（ P 〈 0. 05）. Conclusion 3 D-ASL combined with DWI is safe and noninvasive without injection of contrast agent,they have a great application prospects used in the differential diagnosis of HGG recurrence and pseudo progression.

关 键 词：磁共振成像 3D动脉自旋标记 高级别脑胶质瘤 术后复发 假性进展 

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]