合成MRI联合三维动脉自旋标记成像预测弥漫性胶质瘤分级及肿瘤细胞增殖活性的研究  

Prediction of diffuse glioma grade and tumor cell proliferative activity by synthetic MRI combined with three dimensional arterial spin labeling imaging

作　　者：葛鑫 孙胜玉[2] 刘文潇 赵建国[3] 申颖 吕瑞瑞 黄雪莹[3] 王晓东[3] Ge Xin;Sun Shengyu;Liu Wenxiao;Zhao Jianguo;Shen Ying;Lyu Ruirui;Huang Xueying;Wang Xiaodong(Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;School of Nursing,Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]宁夏医科大学总医院神经外科,银川750004 [3]宁夏医科大学总医院放射科,银川750004 [4]宁夏医科大学护理学院,银川750004

出　　处：《中华放射学杂志》2022年第5期524-529,共6页Chinese Journal of Radiology

基　　金：宁夏回族自治区自然科学基金(2022AAC03487)。

摘　　要：目的探讨合成MRI联合三维动脉自旋标记(3D-ASL)成像对弥漫性胶质瘤分级诊断的应用价值及与肿瘤细胞增殖活性(Ki-67)的相关性。方法本研究为前瞻性研究。分析2020年8月至2021年6月在宁夏医科大学总医院接受颅脑合成MRI和3D-ASL成像的66例弥漫性胶质瘤患者的临床及影像表现。66例患者中男36例、女30例,年龄4~76岁,分为低级别胶质瘤(LGG)组25例(WHOⅡ级)和高级别胶质瘤(HGG)组41例(WHOⅢ、Ⅳ级)。利用GE ADW4.7后处理软件测量肿瘤实质部分T_(1)、T_(2)、质子密度(PD)、脑血流量(CBF)。术后病理切片通过免疫组化检测Ki-67标记指数(Ki-67 LI)。采用独立样本t检验或Mann-Whitney U检验比较HGG组与LGG组各定量参数的差异,采用受试者操作特征(ROC)曲线分析T_(1)、PD、CBF和三者联合的诊断效能,利用Spearman检验分析各参数与Ki-67 LI的相关性。结果HGG组T_(1)[(1573±173)ms]、PD[(86.2±2.4)pu]、CBF[(129±48)ml·100 g^(-1)·min^(-1)]均高于LGG组[分别为(1376±134)ms、(83.0±2.5)pu、(77±49)ml·100 g^(-1)·min^(-1)],差异具有统计学意义(t分别为-4.86、-5.08、-4.24,P<0.01)。ROC显示T_(1)、PD、CBF鉴别HGG与LGG的曲线下面积(AUC)分别为0.847、0.843、0.777。多参数分析中,三者联合的诊断效能最高(AUC=0.973),灵敏度和特异度分别为87.8%和100%。在LGG和HGG组中,T_(1)、T_(2)、PD、CBF与Ki-67 LI无相关性;整体胶质瘤患者中,T_(1)、PD、CBF与Ki-67 LI呈正相关性(r分别为0.394、0.411、0.406,P<0.01);T_(2)与Ki-67 LI无相关性(r=-0.100,P=0.423)。结论合成MRI和3D-ASL可无创评估弥漫性胶质瘤的病理分级并预测Ki-67 LI,其中T_(1)和PD是较好的影像学新指标。Objective To evaluate the value of synthetic MRI combined with three dimensional-arterial spin labeling(3D-ASL)imaging in the grading of diffuse glioma and its correlation with tumor cell proliferative activity(Ki-67).Methods This study was prospective.The clinical and imaging manifestations of 66 patients with diffuse glioma who underwent synthetic MRI combined with 3D-ASL imaging from August 2020 to June 2021 in General Hospital of Ningxia Medical University were analyzed.Among 66 patients,there were 36 males and 30 females,aged 4-76 years,and divided into low grade glioma(LGG)group(n=25)(WHOⅡ)and high grade glioma(HGG)group(n=41)(WHOⅢand vⅣ).T_(1),T_(2),proton density(PD)and cerebral blood flow(CBF)of tumor parenchyma were measured by GE ADW4.7 postprocessing software.The Ki-67 label index(Ki-67 LI)in postoperative pathological sections was detected by immunohistochemistry.Independent sample t test or Mann-Whitney U test was used to compare the differences of quantitative parameters between HGG group and LGG group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of T_(1),PD,CBF and the combination.Spearman test was used to analyze the correlation between the parameters and Ki-67 label index(LI).Results T_(1)[(1573±173)ms],PD[(86.2±2.4)pu]and CBF[(129±48)ml·100 g^(-1)·min^(-1)]in HGG group were significantly higher than those in LGG group[(1376±134)ms,(83.0±2.5)pu and(77±49)ml·100g^(-1)·min^(-1) respectively],and difference had statistical significance(t=-4.86,-5.08,-4.24,P<0.01).ROC confirmed that the area under curve(AUC)of T_(1),PD and CBF in differentiating HGG from LGG were 0.847,0.843 and 0.777,respectively.In multi-parameter analysis,the combination of three parameters had the best diagnostic efficiency(AUC=0.973)and the sensitivity and specificity were 87.8%and 100%,respectively.In LGG and HGG groups,there was no correlation between T_(1),T_(2),PD,CBF and Ki-67 LI.In the overall cohort,T_(1),PD and CBF had slight positive correlation with Ki-67 LI(r

关 键 词：神经胶质瘤 磁共振成像 动脉自旋标记 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.4[医药卫生—诊断学]