动态磁化率对比增强MR灌注成像及MRS在鉴别高级别脑胶质瘤假性进展中的应用  

Application of dynamic susceptibility contrast-enhanced MR perfusion imaging and magnetic resonance spectroscopy in differentiating pseudoprogression of high-grade glioma

作　　者：景辉 秦丹蕾 李俊杰 JING Hui;QIN Danlei;LI Junjie(MRI Room, General Hospital of Taiyuan Iron and steel (Group) Co., Ltd, Taiyuan 030008, P.R.China;School of Medical Imaging, Shanxi Medical University, Taiyuan 030001, P.R.China)

机构地区：[1]山西太原钢铁(集团)有限公司总医院磁共振室,山西太原030008 [2]山西医科大学医学影像学院,山西太原030001

出　　处：《医学影像学杂志》2021年第11期1810-1814,1841,共6页Journal of Medical Imaging

基　　金：国家自然科学基金项目(编号:81971593)。

摘　　要：目的探讨动态磁化率对比增强MR灌注成像(dynamic susceptibility contrast MR perfusion imaging,DSC-PWI)及MRS单独或联合应用在鉴别高级别脑胶质瘤假性进展中的价值。方法选取2013年1月~2020年8月在我院行手术切除术后同步放化疗治疗的高级别脑胶质瘤患者52例进行回顾性分析,所有患者复查时行DSC-PWI及MRS扫描,分析DSC-PWI及MRS相关参数。以病理检查或随访结果为金标准,对比单独或联合应用诊断的灵敏度、特异度、准确度、阳性预测值及阴性预测值,判断DSC-PWI及MRS在鉴别高级别脑胶质瘤假性进展中的应用价值。结果1)52例患者经证实24例为假性进展,28例为肿瘤复发;2)复发组患者病变区、病变边缘区rCBF值均高于假性进展组,组间差异均有统计学意义(P<0.05);复发组患者Cho/NAA、Cho/Cr比值高于假性进展组,组间差异均有统计学意义(P<0.05);3)三种检查方法与金标准结果相当,差异均无统计学意义(P>0.05),DSC-PWI、MRS及联合诊断时灵敏度分别为89.29%、82.14%、89.29%,特异度分别为87.50%、83.33%、95.83%,准确度分别为88.46%、82.69%、92.31%,阳性预测值分别为89.29%、85.19%、96.15%,阴性预测值分别为87.50%、80.00%、88.46%。结论DSC-MRI和MRS联合应用可更好地诊断高级别脑胶质瘤假性进展,具有很高的临床应用价值。Objective To investigate the value of dynamic susceptability contrast MR perfusion imaging(DSC PWI)and magnetic resonance spectroscopy(MRS)in the identification of the false progress of advanced glioma.Methods 52 patients with high-grade gliomas who underwent surgical resection and concurrent chemoradiotherapy in our hospital from January 2013 to August 2020 were selected.DSC-PWI and Mrs scanning were performed during reexamination,and the relevant parameters of dsc-pwi and MRS were analyzed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of dsc-pwi or MRS were compared with those of dsc-pwi or MRS alone to determine the application value of DSC-MR perfusion imaging combined with MRS in the differential diagnosis of pseudoprogression of high-grade glioma.Results 1)Among the 52 patients,24 cases were confirmed as pseudoprogression and 28 cases as tumor recurrence;2)the rCBF values of lesion area and lesion edge area in the recurrence group were higher than those in the pseudo progression group,and the differences were statistically significant(P<0.05);the CHO/NAA and Cho/Cr ratios in the recurrence group were higher than those in the pseudo progression group,and the differences were statistically significant(P<0.05);3)the results of the three methods were similar to those of the pathological examination,and the differences were not statistically significant(P>0.05).The sensitivity of DSC-PWI,MRS and combined diagnosis were 89.29%,82.14%and 89.29%,respectively.The specificity was 87.50%,83.33%and 95.83%respectively.The accuracy was 88.46%,82.69%and 92.31%respectively.The positive predictive values were 89.29%,85.19%and 96.15%,respectively.The negative predictive values were 87.50%,80.00%and 88.46%respectively.Conclusion The combination of DSC-MRI and MRS can better diagnose pseudoprogression of the high-grade glioma and has great clinical value.

关 键 词：脑胶质瘤 假性进展 磁共振成像 磁共振波谱成像 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]