动态磁敏感对比增强灌注加权成像直方图预测原发性中枢神经系统淋巴瘤化疗反应的价值  

Dynamic Susceptibility Contrast-Enhanced Perfusion Weighted Imaging Histogram in Predicting Chemotherapy Response of Primary Central Nervous System Lymphoma

作　　者：张楠 刘国莉[1,2] 王明霄 马林 ZHANG Nan;LIU Guoli;WANG Mingxiao;MA Lin(Medical School of Chinese PLA,Beijing 100853,China;Department of Radiology,the First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心放射诊断科,北京100853

出　　处：《中国医学影像学杂志》2024年第5期439-446,460,共9页Chinese Journal of Medical Imaging

摘　　要：目的探讨治疗前动态磁敏感对比增强灌注加权成像定量参数相对脑血流量(rCBF)和相对脑血容量直方图预测原发性中枢神经系统淋巴瘤(PCNSL)化疗反应的价值。资料与方法回顾性分析2016年9月—2023年10月于解放军总医院第一医学中心接受大剂量氨甲蝶呤化疗的38例PCNSL共57个病灶,根据化疗反应分为缓解组30例和无缓解组8例。分别在脑血流量和脑血容量图像上勾画感兴趣区,并提取直方图参数。采用单因素和多因素Logistic回归分析确定PCNSL化疗反应的独立预测参数,并构建联合预测模型。采用受试者工作特征曲线下面积比较各参数及联合模型的预测效能。结果病灶数量(OR=9.726,95%CI 1.070~88.397,P=0.043)、rCBF90(OR=0.224,95%CI 0.072~0.704,P=0.010)是PCNSL化疗反应的独立预测因素,曲线下面积分别为0.681、0.798,多发病变和rCBF90较小的PCNSL化疗反应性更差。rCBF90+病变数量联合模型的预测效能最好,曲线下面积为0.846。结论治疗前动态磁敏感对比增强定量参数rCBF和相对脑血容量直方图可以预测PCNSL患者化疗反应,rCBF90是PCNSL患者化疗反应的独立预测因子。Purpose To investigate the value of pre-treatment relative cerebral blood flow(rCBF)and relative cerebral blood volume histogram of dynamic susceptibility contrast-enhanced perfusion weighted imaging in predicting the chemotherapy response of primary central nervous system lymphoma(PCNSL)patients.Materials and Methods Thirty-eight PCNSL patients with fifty-seven lesions treated with high-dose methotrexate chemotherapy from September 2016 to October 2023 were retrospectively involved in the study.The patients were divided into response group of 30 patients and non-response group of 8 patients.Region of interest was drawn in cerebral blood flow and cerebral blood volume images,and histogram paraments were extracted.Univariate and multivariate Logistic regression analysis were performed to identify the independent predictors for chemotherapy response in PCNSL,and then combined prediction model was constructed.The area under the receiver operating characteristic curve was used to compare the predictive performance of different paraments and combined model.Results The number of lesions(OR=9.726,95%CI 1.070-88.397,P=0.043)and rCBF90(OR=0.224,95%CI 0.072-0.704,P=0.010)were the independent predictors for chemotherapy response with the area under the curve of 0.681 and 0.798,respectively.The combined model of rCBF90 and the numbers of lesions showed the best predictive performance with the area under the curve of 0.846.Conclusion The pre-treatment quantitative parameters rCBF and relative cerebral blood volume of dynamic susceptibility contrast-enhanced perfusion weighted imaging could be used for predicting the response to high-dose methotrexate chemotherapy in PCNSL patients,and the rCBF90 is an independent predictor of chemotherapy response.

关 键 词：神经淋巴瘤病 中枢神经系统肿瘤 淋巴瘤 非何杰金 磁共振成像 灌注加权成像 氨甲蝶呤 化学疗法 辅助 

分 类 号：R445.2[医药卫生—影像医学与核医学] R733[医药卫生—诊断学]