集成MRI联合三维动脉自旋标记成像鉴别胶质瘤复发和假性进展的初步研究  

Preliminary study of synthetic MRI combined with three-dimensional arterial spin labeling imaging in differentiating recurrence and pseudoprogression of glioma

作　　者：吕瑞瑞 杨治花 葛鑫 王明磊[3] 黄雪莹[3] 刘珊[3] 马文富 王晓东[3] Lü Ruirui;YANG Zhihua;GE Xin;WANG Minglei;HUANG Xueying;LIU Shan;MA Wenfu;WANG Xiaodong(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Department of Radiotherapy,Cancer Hospital,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,General Hospital of 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肿瘤医院放疗科,银川750004 [3]宁夏医科大学总医院放射科,银川750004

出　　处：《磁共振成像》2022年第8期19-23,35,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：宁夏回族自治区自然科学基金(编号:2022AAC03487);宁夏回族自治区科技重点研究计划(编号:2019BEG03037)。

摘　　要：目的探讨集成MRI(synthetic magnetic resonance imaging,syMRI)联合三维动脉自旋标记成像(three dimension arterial spin labeling,3D-ASL)在鉴别胶质瘤复发和假性进展中的应用价值。材料与方法回顾性分析2020年7月至2022年3月于宁夏医科大学总医院手术病理证实为高级别胶质瘤并术后辅以放化疗后出现异常强化灶患者病例38例。将入组病例按修订版脑胶质瘤治疗反应评估标准分为复发组(22例)和假性进展组(16例)。所有患者均行3D-ASL及syMRI序列扫描。测量异常强化区脑血流量(cerebral blood flow,CBF)及增强后T1值(T1-Gd)、T2值(T2-Gd)。采用独立样本t检验或Mann-Whitney U检验比较复发组和假性进展组各参数的差异,对差异具有统计学意义的参数绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析评价各参数及其联合诊断的效能。结果复发组T1-Gd低于假性进展组T1-Gd,差异有统计学意义(P<0.001),T2-Gd两组间差异无统计学意义(P>0.05),复发组CBF值高于假性进展组,差异有统计学意义(P<0.001)。ROC曲线分析结果显示,T1-Gd、CBF值ROC曲线下面积(area under the curve,AUC)分别为0.882、0.916,T1-Gd联合CBF值的AUC为0.951。结论syMRI联合3D-ASL有助于无创鉴别脑胶质瘤复发和假性进展,且诊断效能优于单一MR参数。Objective: To evaluate the value of synthetic MRI(synthetic MRI, syMRI) combined with three-dimensional arterial spin labeling imaging(3D-ASL) in differentiating recurrence and pseudoprogression of glioma. Materials and Methods: Thirty-eight patient cases with surgical pathologically confirmed glioma and abnormal enhancing foci after postoperative adjuvant radiotherapy at the General Hospital of Ningxia Medical University from July 2020 to March 2022 were collected. The enrolled cases were divided into recurrence group(22 cases) and pseudoprogression group(16 cases) according to the Modified Criteria for Radiographic Response Assessment in Glioblastoma(mRANO). All patients underwent 3D-ASL and syMRI serial scans. The cerebral blood flow(CBF) value of abnormal enhancement area and post-enhancement T1 value(T1-Gd) and T2 value(T2-Gd) were measured.Independent sample t test or Mann-Whitney U test was used to compare the differences of parameters between recurrence and pseudoprogression group. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic efficacy of T1-Gd, CBF and the combination. Results: T1-Gd in recurrence group was lower than T1-Gd in pseudoprogression group, and the difference was statistically significant(P<0.001). The difference between the two groups in T2-Gd was not statistically significant(P>0.05). The CBF value in recurrence group was higher than that in pseudoprogression group, and the difference was statistically significant(P<0.001). The results of ROC curve analysis showed the area under the curve(AUC) was 0.882 and 0.916 for T1-Gd and CBF values,and the AUC was 0.951 for T1-Gd combined with CBF values. Conclusions: Synthetic MRI combined with 3D-ASL is helpful to non-invasively distinguish the recurrence and pseudoprogression of glioma, and its diagnostic efficiency is better than that of single MR parameter.

关 键 词：胶质瘤 复发 假性进展 集成磁共振成像 三维动脉自旋标记成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.264[医药卫生—诊断学]