MR弥散成像(DWI)在脑胶质瘤诊断、术前分型及手术指导中的应用观察  

Application of MR Diffusion-Weighted Imaging(DWI)in Diagnosis,Preoperative Classification,and Operation Guidance of Gliomas

作　　者：王虎[1] 姚倩东[1] 芮军 顾聪 WANG Hu;YAO Qian-dong;RUI Jun;GU Cong(Department of Radiology,Sichuan Science City Hospital,Mianyang 621990,Sichuan Province,China)

机构地区：[1]四川省科学城医院放射科,四川绵阳621900

出　　处：《中国CT和MRI杂志》2022年第2期14-17,共4页Chinese Journal of CT and MRI

摘　　要：目的为了解磁共振弥散加权成像(DWI)在脑胶质瘤诊断、术前分型及手术指导中的应用价值。方法回顾性分析我院2017年1月至2019年6月期间收治的62例脑肿瘤患者的临床资料,其中21例为单发脑转移瘤患者,19例低级别胶质瘤(WHO Ⅰ~Ⅱ),22例高级别胶质瘤(WHO Ⅲ~Ⅳ),所有患者均进行常规T_(1)WI、T_(2)WI平扫,DWI及增强扫描,并测量肿瘤实质、瘤周水肿区、对侧正常区的ADC值,利用受试工作特征曲线(ROC)评估瘤实质区ADC值对脑胶质瘤分级的价值,同时统计患者术后肿瘤镜下全切率、致残率。结果脑胶质瘤和转移瘤实质区及瘤周水肿区ADC值均高于对侧正常区(P<0.05),并且脑转移瘤瘤周水肿区ADC值和rADC-p值要高于脑胶质瘤(P<0.05);低级别脑胶质瘤的瘤实质区、瘤周水肿区ADC、rADC-t、rADC-p值均高于高级别胶质瘤(P<0.05)。ROC结果显示,瘤实质区ADC值诊断脑胶质瘤级别的AUC为0.830,95%CI为0.705~0.955,最佳临界点为1.165×10^(-3)mm^(2)/s。参考DWI进行脑胶质瘤患者肿瘤切除的镜下全切率为64.29%(27/42),术后致残率为21.43%(9/42)。结论参考DWI检查的瘤周水肿区ADC值和rADC-p值能够有助于鉴别脑转移瘤和脑胶质瘤,而瘤实质区ADC值可帮助术前脑胶质瘤分级,并且还能指导术者最大范围切除瘤体,降低术后致残率。Objective In order to understand the application value of magnetic resonance(MR)diffusion-weighted imaging(DWI)in the diagnosis,preoperative classification and operation guidance of gliomas.Methods A retrospective analysis was performed on the clinical data of 62 brain tumor patients who were admitted to the hospital from January 2017 to June 2019,including 21 cases with solitary brain metastases,19 cases with low-grade gliomas(WHO Ⅰ-Ⅱ)and 22 cases with high-grade gliomas(WHO Ⅲ-Ⅳ).All underwent routine T_(1)WI and T_(2)WI plain scans,DWI and enhancement scan.ADC values of tumor parenchyma,peritumoral edema and contralateral normal areas were measured.The value of ADC values in tumor parenchyma area in grading of gliomas was evaluated by receiver operating characteristic(ROC)curves.The postoperative complete resection rate of tumors under endoscope and disability rate were statistically analyzed.Results ADC values of brain metastases and gliomas in tumor parenchyma and peritumoral edema areas were higher than those in contralateral normal area(P<0.05).ADC and rADC-p values of brain metastases were higher than those of gliomas in peritumoral edema area(P<0.05).ADC,rADC-t and rADC-p values of low-grade gliomas were higher than those of high-grade gliomas in tumor parenchyma and peritumoral edema areas(P<0.05).ROC results showed that ADC,95%CI and the optimal cut-off value of ADC values in tumor parenchyma area for diagnosis of gliomas grading were 0.830,0.705~0.955 and 1.165×10^(-3)mm^(2)/s,respectively.According to DWI,complete resection rate of tumors under endoscope and disability rate were 64.29%(27/42)and 21.43%(9/42),respectively.Conclusion ADC and rADC-p values in peritumoral edema area based on DWI are conducive to identifying brain metastases and gliomas.ADC values in tumor parenchyma area can help preoperative grading of gliomas,guide tumor resection to the greatest extent and reduce postoperative disability rate.

关 键 词：脑胶质瘤 肿瘤分级 磁共振DWI 表观扩散系数值 

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