三维动脉自旋标记技术在胶质瘤术后复发诊断中的价值  

Diagnostic value of three dimensional arterial spin labeling in evaluation of postoperative recurrence of glioma

作　　者：王涛[1,2] 周鹏[3] 田冲 刘远成 段庆红 Wang Tao;Zhou Peng;Tian Chong;Liu Yuancheng;Duan Qinghong(不详;Departmet of Imaging and Nuclear Medcine,Guizhou Medical University,Guiyang 550000,China)

机构地区：[1]贵州医科大学影像医学与核医学系,贵州贵阳550000 [2]贵州省人民医院放射科,贵州贵阳550002 [3]贵州省德江县人民医院放射科,贵州德江565206

出　　处：《中国中西医结合影像学杂志》2020年第2期128-131,156,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：贵州省软科学研究计划项目(黔联合LS字〔2012〕023号)。

摘　　要：目的:探讨三维动脉自旋标记技术(3D-ASL)对胶质瘤术后复发的诊断价值。方法:回顾性分析15例经第2次手术切除或活检病理证实的胶质瘤复发患者的临床及影像资料;术后每3个月(第3、6、9个月)复查MRI增强扫描及3D-ASL检查,追踪测量病变强化区域范围大小、病变及正常对照区脑血流量(CBF)值、相对脑血流量(r CBF)值,采用方差分析灌注参数变化以评价肿瘤变化趋势;3名医师分别对MRI增强扫描、3D-ASL图像及两者联合图像进行肿瘤复发的判断。结果:15例中,第2次术后第3、6、9个月出现异常强化病灶分别为5、11、13例;3D-ASL呈相对高灌注分别为8、12、13例,病变区域平均CBF值分别为(68.46±17.01)、(76.45±17.50)、(80.21±18.11)mL/(100 g·min),平均r CBF值为1.92±0.44、2.28±0.46、2.51±0.51,经方差检验分析发现术后第3个月与第6个月、第3个月与第9个月CBF值差异均有统计学意义(均P<0.05),第3个月与第9个月r CBF值比较,差异有统计学意义(P<0.05)。常规MRI增强扫描与3D-ASL对胶质瘤术后第6个月复发的诊断准确率差异有统计学意义(P<0.05)。结论:胶质瘤术后复发病灶在3D-ASL随访过程中呈相对高灌注表现,且CBF、r CBF值随着病程进展出现灌注增加的趋势。较常规MRI增强扫描,动态观测CBF、r CBF变化结合MRI增强扫描有利于提高胶质瘤复发的诊断准确率。Objective:To investigate the diagnostic value of three-dimensional arterial spin labeling(3D-ASL)for the recurrenceof glioma.Methods:15 patients confirmed as recurrence of glioma after surgery,radiotherapy and chemotherapy were retrospectivelyanalyzed;postoperative contrast enhancement MRI and 3D-ASL examination were performed every 3 months;the lesion size were measured.The value of cerebral blood flow(CBF)and relative CBF(rCBF)were analyzed.The changes of MRI enhancement range and perfusion change trend were analyzed,and the value of 3D-ASL in the diagnosis of postoperative recurrence of gliomawas compared.Results:Fifteen cases of postoperative recurrence of gliomas were followed up for 9 months.In the enhancedimages,abnormal enhancement lesions at the 3rd,6th and 9th month were observed as 5,11,13 cases,respectively.In the3D-ASL imaging,8,12,13 cases showed relatively high perfusion at the 3rd,6th,and 9th months,respectively.The mean CBFvalues in the lesion area at the 3rd,6th,9th month were(68.46±17.01),(76.45±17.5),and(80.21±18.11)mL/100 g/min,respectively,and the average rCBF values were 1.92±0.44,2.28±0.46 and 2.51±0.51,respectively.The CBF value of the 3rd month had significant differences with that of the 6th and 9th month(both P<0.05),and the rCBF value of the 3rd month had significant difference with that of the 9th month(P<0.05).For the diagnostic accuracy of contrast enhancement MRI and 3D-ASL examination,a significant difference(P<0.05)were found at the 6th months between the two methods.Conclusion:The postoperative recurrence of glioma is manifested as relative high perfusion in 3D-ASL follow-up imaging,and the CBF value appears to increase with the course of the disease.The dynamic observation of CBF combined with r-CBF changes benefit for evaluating tumor recurrence.3D-ASL combine with MRI enhanced examination benefit for improving the diagnostic accuracy of tumor recurrence.

关 键 词：磁共振成像 神经胶质瘤 复发 

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]