3D-ASL的rCBF max值在儿童后颅窝肿瘤鉴别诊断中的价值  

Value of rCBF max of 3D-ASL for differential diagnosis of pediatric posterior fossa tumors

作　　者：盛思思 邵剑波[1] 彭雪华 郭豫 朱百奇 SHENG Si-si;SHAO Jian-bo;PENG Xue-hua(Department of Radiology,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan Clinical Research Center for Children’s Medical Imaging,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)影像中心/武汉市儿童影像医学临床医学研究中心,湖北武汉430016

出　　处：《放射学实践》2024年第4期523-527,共5页Radiologic Practice

摘　　要：目的:探讨三维动脉自旋标记成像(3D-ASL)参数rCBF_(max)对儿童后颅窝肿瘤的诊断价值。方法:回顾性分析2018年1月-2022年12月在本院经手术病理证实的52例后颅窝肿瘤患儿的临床和术前MRI资料(平扫、增强和3D-ASL)。其中,髓母细胞瘤28例,毛细胞星形细胞瘤11例,室管膜瘤13例。测量肿瘤实性区域的最大脑血流量(CBF_(max))值,并计算最大相对脑血流量(rCBF_(max)=CBF_(max)/CBF_(健侧正常脑灰质))。采用Kruskal-Wallis检验比较3组肿瘤的rCBF_(max)值,采用ROC曲线和约登指数来确定rCBF_(max)鉴别肿瘤病理类型的最佳阈值、敏感度、特异度和曲线下面积(AUC)。结果:室管膜瘤的rCBF_(max)值最高,为1.53(1.27,2.04),毛细胞星形细胞瘤的rCBF_(max)值最低,为0.69(0.56,0.76),髓母细胞瘤的rCBF_(max)值为0.90(0.84,1.00)。三组肿瘤的rCBF_(max)值比较,差异有统计学意义(P<0.001)。ROC曲线分析显示鉴别室管膜瘤与髓母细胞瘤的rCBF_(max)最佳阈值为1.13,相应的诊断敏感度为100%,特异度为82.1%,AUC为90.7%;鉴别髓母细胞瘤与毛细胞星形细胞瘤的rCBF_(max)最佳阈值为0.80,相应的诊断敏感度为85.7%,特异度为100%,AUC为97.1%。结论:3D-ASL定量参数rCBF_(max)对常见儿童后颅窝肿瘤的鉴别诊断具有较高的临床应用价值。Objective:To investigate the value of maximum relative cerebral blood flow(rCBF_(max))of three-dimensional arterial spin labeling(3D-ASL)imaging in the differential diagnosis of posterior fossa tumors in children.Methods:Clinical and preoperative MRI data(plain scan,enhanced scan and 3D-ASL)of 52 children with posterior cranial fossa tumors confirmed by surgery and pathology in our hospital from January 2018 to December 2022 were retrospectively analyzed,including 28 cases of medulloblastoma,11 cases of pilocytic astrocytoma and 13 cases of ependymoma,which were divided into three corresponding groups.All the children underwent MRI brain scan before surgery,including plain scan,enhanced scan and 3D-ASL.Maximum cerebral blood flow(CBF_(max))was measured in the solid part of the tumor and the ratio was compared with the cerebral blood flow(CBF)of normal gray matter on the healthy side to obtain the maximum relative cerebral blood flow(rCBF_(max)).Kruskal-Wallis test was used to compare rCBF_(max)values of the three groups of tumors,and ROC curve and Jorden index were used to determine the optimal threshold,sensitivity,specificity and area under the curve(AUC)of rCBF_(max)in differentiating tumor pathological types.Results:The rCBFmax value of ependymoma was the highest[1.53(1.27,2.04)],the rCBF_(max)value of pilocytic astrocytoma was the lowest[0.69(0.56,0.76)],and that of medulloblastoma[0.90(0.84,1.00)]was between the two.Comparisons of rCBF_(max)values among the three groups showed statistically significant differences(all P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the best rCBF_(max)cut-off for distinguishing ependymoma from medulloblastoma was 1.13,the corresponding diagnostic sensitivity was 100%,the specificity was 82.1%,and the AUC was 90.7%.The best rCBF_(max)cut-off for distinguishing medulloblastoma from pilocytic astrocytoma was 0.80,with a corresponding diagnostic sensitivity of 85.7%,specificity of 100%,and AUC of 97.1%.Conclusion:The rCBF_(max)value of 3D-ASL has applic

关 键 词：后颅窝肿瘤 儿童 动脉自旋标记成像 脑血流量 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]