3D-PCASL成像技术在弥漫性胶质瘤术前分级及IDH突变状态预测中的价值  

The value of 3D-PCASL imaging technique in grading and IDH mutation status of diffuse glioma

作　　者：曾颖卿 谢伟[1] 李宗芳[1] 唐丹[1] 马玉燕 赵琪瑞 包含 ZENG Yingqing;XIE Wei;LI Zongfang;TANG Dan;MA Yuyan;ZHAO Qirui;BAO Han(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院影像科,云南昆明650032

出　　处：《实用放射学杂志》2022年第5期693-697,共5页Journal of Practical Radiology

基　　金：云南省基础研究计划(昆医联合专项)[2019FE001(-052)];云南省教育厅科学研究基金项目(2019Y0354);昆明医科大学研究生创新基金项目(2020S157).

摘　　要：目的探讨三维伪连续式动脉自旋标记(3D-PCASL)成像技术对弥漫性胶质瘤术前分级、瘤周浸润及异柠檬酸脱氢酶(IDH)突变状态预测的价值。方法选取经病理确诊为弥漫性胶质瘤患者50例,其中20例低级别胶质瘤(Ⅱ,Ⅲ级)、30例高级别胶质瘤(Ⅳ级),18例IDH突变型,32例IDH野生型。对其进行常规MRI及3D-PCASL扫描,分别测量肿瘤实体区、距离肿瘤边缘1 cm内、肿瘤边缘1~2 cm脑血流量(CBF)和相对脑血流量(rCBF),对各参数进行统计分析。结果除距离肿瘤边缘1~2 cm CBF、rCBF差异无统计学意义外(P>0.05),余低级别、IDH突变型瘤体及距离肿瘤边缘1 cm内CBF、rCBF均低于高级别、IDH野生型(P<0.05)。对弥漫性胶质瘤的术前分级,最大rCBF(rCBFmax)诊断效能最高,曲线下面积(AUC)为0.857,最佳阈值为0.5 mL/100 g,敏感度72.2%,特异度87.2%;对IDH突变状态的预测,平均rCBF(rCBFmean)诊断效能最高,AUC为0.869,最佳阈值为0.49 mL/100 g,敏感度77.8%,特异度93.7%。低级别及IDH突变型瘤周各区CBF差异无统计学差异(P>0.05),高级别中距离肿瘤1 cm内CBF、rCBF高于1~2 cm(P<0.05),IDH野生型组瘤周CBF、rCBF差异不明显,但距离肿瘤1 cm内CBF有高于正常脑实质、1~2 cm有低于正常脑实质的趋势。结论rCBF有助于弥漫性胶质瘤术前分级及IDH基因突变状态预测,瘤周CBF在一定程度上可评估肿瘤浸润范围,为术区范围提供帮助。Objective To investigate the value of three-dimensional pseudo-continuous arterial spin labeling(3D-PCASL)imaging technique in predicting preoperative grading,peritumoral invasion and isocitrate dehydrogenase(IDH)mutation status of diffuse glioma.Methods A total of 50 cases of diffuse glioma confirmed by histopathology examination were involved,which included 20 cases of low-grade gliomas with grade II or grade ID,30 cases of high-grade gliomas with grade IV,18 cases were IDH mutants and 32 were IDH wild types.Routine MRI and 3D-PCASL scans were performed.The values of cerebral blood flow(CBF)and relative CBF(rCBF)were measured in the tumor area,within 1 cm and 1-2 cm range of tumor margin.Results Except for the values of CBF and rCBF within 1-2 cm of tumor margin,the values of other CBF and rCBF of IDH mutants and low-grade gliomas were significantly lower than those of IDH wild types and high-grade gliomas(P<0.05).For glioma grading,the area under the curve(AUC)of rCBFmax was 0.857,when the cut-off was 0.5 mL/100 g,and the sensitivity and specificity were 72.2%and 87.2%,respectively.For the prediction of IDH mutation status,the AUC of rCBFmean was 0.896,when the cut-off was 0.49 mL/100 g,and the sensitivity and specificity were 77.8%and 93.7%Respectively.The values of CBF and rCBF within 1 cm from tumor margin were higher than those within 1-2 cm in high-grade gliomas(P<0.05).In IDH wild types group,although there were no significant difference of the values of CBF and rCBF between normal brain parenchyma and peritumoral areas,they had a tendency that the values of CBF and rCBF within 1 cm from tumor margin were higher than those of normal brain parenchyma,but the values of CBF and rCBF within 1-2 cm from tumor margin were lower.Conclusion rCBF is helpful to predict the preoperative grading and IDH gene mutation status of diffuse glioma.In addition,peritumoral CBF helps to evaluate the range of tumor invasion to certain extent and provides help for the selection of surgical area.

关 键 词：弥漫性胶质瘤 磁共振成像 动脉自旋标记 异柠檬酸脱氢酶 

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