多模态MRI对高级别胶质瘤术后复发和假性进展的鉴别诊断  

Multimodal MRI for postoperative recurrence and pseudoprogression of high-grade glioma

作　　者：王兴兰[1] 杨全[1] 刘文罡 李晓燕[1] 苏丽平[1] 应洁 刘丹[1] WANG Xing-lan;YANG Quan;LIU Wen-gang;LI Xiao-yan;SU Li-ping;YING Jie;LIU Dan(Department of Radiology,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,CHINA)

机构地区：[1]重庆医科大学附属永川医院放射科,重庆402160

出　　处：《海南医学》2020年第14期1857-1860,共4页Hainan Medical Journal

基　　金：重庆市永川区科委科技项目(编号:2016nc5006)。

摘　　要：目的探讨多模态磁共振成像(MRI)对高级别胶质瘤术后复发和假性进展的鉴别诊断价值。方法回顾性分析重庆医科大学附属永川医院肿瘤科2016年1月至2018年12月期间收治且经病理证实的21例高级别胶质瘤术后复发患者和17例假性进展患者的临床和影像资料,所有患者均行常规MRI及扩散加权成像(DWI)、磁共振波谱成像(1H-MRS)、灌注加权成像(PWI)影像扫描。结果术后复发与假性进展患者发生时间分别为18(11,25)个月和2(2,5)个月,差异具有统计学意义(P<0.05);术后复发与假性进展的脑血容量(rCBV)比值分别为2.95(1.54,4.82)、0.96(0.45,4.18),脑血流量(rCBF)比值为2.68(1.91,4.16)和1.21(0.79,3.19),差异均具有统计学意义(P<0.05),而平均通过时间(rMTT)、达峰时间(rTTP)、表观弥散系数(rADC)、胆碱/N-乙酰天门冬氨酸(Cho/NAA)、胆碱/肌酸(Cho/Cr)比较差异均无统计学意义(P>0.05);r CBV、rCBF和各参数联合诊断肿瘤复发及假性进展的ROC曲线下面积(AUC)分别为0.780、0.793、0.867。结论多模态MRI的联合应用对高级别胶质瘤术后复发和假性进展的鉴别具有更高的诊断价值,可为临床治疗方案的选择及评估预后提供参考。Objective To explore the value of multimodal magnetic resonance imaging(MRI)in the differential diagnosis of postoperative recurrence and pseudo-progression of high-grade gliomas.Methods The clinical and imaging data of 21 patients with postoperative recurrence of high-grade glioma and 17 patients with pseudoprogression admitted to the Department of Oncology,Yongchuan Hospital Affiliated to Chongqing Medical University from January 2016 to December 2018 were analyzed retrospectively.All patients underwent conventional MRI and diffusionweighted imaging(DWI),magnetic resonance spectroscopy(1 H-MRS),and perfusion-weighted imaging(PWI)image scans.Results The time of recurrence and pseudoprogression was 18(11,25)months and 2(2,5)months,respectively,and the difference was statistically significant(P<0.05).The ratio of regional cerebral blood volume(rCBV)was 2.95(1.54,4.82),0.96(0.45,4.18),and the ratio of regional cerebral blood flow(rCBF)was 2.68(1.91,4.16)and 1.21(0.79,3.19),with statistically significant difference(P<0.05).But,mean transit time ratio(rMTT),time to peak ratio(rTTP),apparent dispersion coefficient(rADC),choline/N-acetylaspartate(Cho/NAA),choline/creatine(Cho/Cr)showed no significant difference(P>0.05).The area under the curve(AUC)of rCBV,r CBF,and the combination of parameters was 0.780,0.793,and 0.867,respectively.Conclusion The combined application of multimodal MRI had a higher diagnostic value to differentiate recurrence and pseudoprogression of high-grade gliomas,which provides a reference for the selection of clinical treatment plan and the evaluation of prognosis.

关 键 词：多模态 磁共振成像 胶质瘤 复发 假性进展 

分 类 号：R730.264[医药卫生—肿瘤]