t-ASL联合3D-ASL在脑膜瘤血供评估中的应用价值  

The clinical utility of t-ASL combined with 3D-ASL in evaluating the blood supply of meningiomas

作　　者：王猛 彭云[2] 尚松安[1] 孙骏 李洁 朱庆强 张洪英 叶靖 吴晶涛 WANG Meng;PENG Yun;SHANG Song’an;SUN Jun;LI Jie;ZHU Qingqiang;ZHANG Hong ying;YE Jing;WU Jingtao(Department of Radiology , Northern Jiangsu People's Hospital,Clinical Medical College of Yangzhou University ,Yangzhou 225001,China;Department of Radiology ,the Second Xiangya Hospital of Central South University,Changsha 410000 ,China)

机构地区：[1]扬州大学临床医学院苏北人民医院影像科,江苏扬州225001 [2]中南大学湘雅二医院影像科,湖南长沙410000 [3]中国医学科学院肿瘤医院深圳医院

出　　处：《实用放射学杂志》2019年第8期1201-1205,共5页Journal of Practical Radiology

基　　金：江苏省“333工程”培养资金资助项目(BRA2017154);国家自然科学基金资助项目(81571652);扬州市社会发展项目(YZ2018059)。

摘　　要：目的探讨动脉自旋标记(ASL)灌注成像技术对脑膜瘤血供源性的影像学评估效价及其对临床外科手术的指导意义。方法选取手术切除且经病理证实的脑膜瘤患者共31例,回顾性分析患者的常规MR平扫、三维时间飞跃法磁共振血管成像(3D-TOF-MRA)、选择性动脉自旋标记(t-ASL)、三维动脉自旋标记(3D-ASL)灌注成像及增强扫描影像资料。采用一致性检验(Kappa检验)评估3D-TOF-MRA与手术记录;t-ASL与手术记录;t-ASL、3D-ASL联合应用与手术记录所显示的肿瘤血供源性的一致性。结果手术结果显示脑膜瘤血供有如下几种:颈内动脉(ICA)(n=8),椎基底动脉(BA)(n=4),颈外动脉(ECA)(n=15),ICA+ECA(n=3),ICA+BA(n=1)。18例3D-TOF-MRA与手术结果一致,Kappa值为0.43,一致性中等;23例t-ASL与手术结果一致,Kappa值为0.64,一致性较强;29例t-ASL、3D-ASL联合应用评估肿瘤血供源性,与手术结果一致,Kappa值为0.91,一致性强。结论联合应用t-ASL、3D-ASL能提高识别脑膜瘤血供源性的准确性,对手术方案制订及预后评估有重要的临床参考价值。Objective To explore the utility of ASL in evaluation the sources of blood supply and its guiding significance for clinical surgery in meningioma.Methods A total of 31 patients with meningioma who had undergone surgical resection and pathological confirmation were enrolled.The routine MR,3D-TOF-MRA,t-ASL,3D-ASL and enhanced scan images of each case were analyzed retrospectively. Consistency test (Kappa test) was used to evaluate the intei-modality agreement between 3D-TOF-MRA and surgical records,t-ASL and surgical records,t-ASL combined with 3D-ASL and the surgical records.Results The records of the surgery showed that the blood supply of meningioma were as follows:ICA (n=8),BA (n=4),ECA (n=15),ICA+ ECA (n=3),ICA+BA (n=1).Intermodality agreement between 3D-TOF-MRA and the surgical results was moderate (Kappa =0.43);t-ASL and the operative results was very good (Kappa=0.64);t-ASL combined with 3D-ASL and the operative results was excellent (Kappa=0.91).Conclusion The combined application of t-ASL and 3DASL can improve the accuracy and feasibility in recognizing the blood supply of the meningioma. It has important clinical reference value for surgical planning and prognosis evaluation.

关 键 词：脑膜瘤 磁共振成像 动脉自旋标记 

分 类 号：R739.45[医药卫生—肿瘤] R445.2[医药卫生—临床医学]