不同磁共振成像模式判断胶质母细胞瘤预后研究  

The comparative study of multimodal MRI techniques in prognosis of glioblastoma

作　　者：陈红燕[1] 陈绪珠[1] 茹小娟[4] 张月青[1] 汪晓鹏 黄伟 任晓辉[2] 林松[2] 李洋 吴涛 刘亚欧 CHEN Hong-yan;CHEN Xu-zhu;RU Xiao-juan;ZHANG Yue-qing;WANG Xiao-peng;HUANG Wei;REN Xiao-hui;LIN Song;LI Yang;WU Tao;LIU Ya-ou(Department of Radiology,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Puren Hospital,Beijing 100062,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Information Centre,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;GE Medical System Trade Development(Shanghai)Limited Company,Shanghai 100176,China)

机构地区：[1]首都医科大学附属北京天坛医院放射科,100070 [2]首都医科大学附属北京天坛医院神经外科,100070 [3]首都医科大学附属北京天坛医院信息中心,100070 [4]北京市神经外科研究所,100070 [5]北京市普仁医院神经外科,100062 [6]通用电气医疗系统贸易发展(上海)有限公司,100176

出　　处：《中国现代神经疾病杂志》2019年第11期850-857,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目（项目编号：81772005）;国家自然科学基金资助项目（项目编号：81771309）;国家自然科学基金资助项目（项目编号：81571632）;国家自然科学基金青年科学基金资助项目（项目编号：81401381)~~

摘　　要：目的探讨动态磁敏感增强灌注成像(DSC-MRI)、三维动脉自旋标记(3D-ASL)和体素内不相干运动成像(IVIM)这3种反映肿瘤组织灌注情况的影像学指标对胶质母细胞瘤预后的预测价值。方法纳入2016年8月至2017年10月住院治疗的34例胶质母细胞瘤患者,根据总生存期分为<14个月组(17例)和≥14个月组(17例),术前行MRI常规扫描,以及DSC-MRI、3D-ASL、IVIM扫描,于肿瘤强化区域和强化肿瘤瘤周区域勾画兴趣区,记录DSC-最大相对脑血容量(rCBVmax)值和相对脑血流量(r CBF)值、ASL-脑血流量(CBF)值、IVIM-灌注分数(PF)值,绘制受试者工作特征曲线(ROC曲线)评价各项影像学指标对判断预后的参考价值。结果在肿瘤强化区域,总生存期<14个月组与≥14个月组患者ASL-CBF值、IVIM-PF值、DSC-rCBF值、DSC-rCBVmax值差异无统计学意义(均P> 0.05);在强化肿瘤瘤周区域,总生存期<14个月组患者IVIM-PF值低于(P=0.011)、DSC-rCBF值(P=0.009)和DSC-rCBVmax值(P=0.012)高于≥14个月组。绘制强化肿瘤瘤周区域ASL-CBF值、DSC-rCBF值和DSC-rCBVmax值的ROC曲线,曲线下面积分别为0.579(95%CI:0.372~0.787,P=0.453)、0.763(95%CI:0.588~0.937,P=0.013)和0.746(95%CI:0.565~0.926,P=0.020),提示DSC-rCBF值和DSC-rCBVmax值对预后判断的参考价值更佳。结论 DSC-rCBF值和DSC-rCBVmax值对胶质母细胞瘤的预后判断的参考价值更佳,而ASL和IVIM序列未显示出较好的预后判断价值。Objective To investigate the prognostic value of dynamic susceptibility contrast-enhanced MRI(DSC-MRI),3 D-arterial spin labeling(3 D-ASL)and intravoxel incoherentmotion(IVIM)in glioblastoma.Methods From August 2016 to October 2017,a total of 34 patients with glioblastoma were enrolled.According to the overall survival(OS),they were divided into<14 months group(17 cases)and≥14 months group(17 cases).MRI conventional sequences,DSC-MRI,3 D-ASL,IVIM were acquired before operation.Multiple regions of interest(ROIs)were placed in the tumor-enhanced region and the peritumoral region,and recorded the values of DSC-maximum relative cerebral blood volume(DSC-rCBVmax)and relative cerebral blood flow(DSC-rCBF),ASL-cerebral blood flow(ASL-CBF),IVIM-perfusion fraction(PF).Receiver operating characteristic(ROC)curve was used to evaluated the prognostic value of the imaging indicators.Results There were no significant differences in ASL-CBF,IVIM-PF,DSC-rCBF andDSC-r CBVmaxbetween the OS<14 months group and the OS≥14 months group in tumor-enhanced region(P>0.05,for all).In the peritumoral region,the IVIM-PF of the patients in OS<14 months was lower(P=0.011)while DSC-r CBF(P=0.009)and DSC-r CBVmax(P=0.012)were higher than OS≥14 months group.The area under the ROC curve was 0.579(95%CI:0.372-0.787,P=0.453),0.763(95%CI:0.588-0.937,P=0.013)and 0.746(95%CI:0.565-0.926,P=0.020)respectively,suggesting that DSC-r CBF and DSC-r CBVmaxhave better reference value for prognosis.Conclusions The imaging indicators of DSC-MRI havean effect on the OS of glioblastoma,while IVIM and ASL have not shown an effect on overall survival.

关 键 词：胶质母细胞瘤 磁共振成像 预后 

分 类 号：R73[医药卫生—肿瘤]