中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2013, Vol. 35 ›› Issue (4): 416-421.doi: 10.3881/j.issn.1000-503X.2013.04.011

• 论著 • 上一篇    下一篇

磁共振对比剂灌注成像在鉴别胶质瘤复发与放射性脑损伤中的应用

王玉林1,刘梦雨1,王 岩1,肖华锋1,孙 璐2,张 军3,马 林1   

  1. 中国人民解放军总医院 1放射诊断科 2病理科 3神经外科,北京 100853
  • 收稿日期:2013-02-19 出版日期:2013-08-30 发布日期:2013-08-30
  • 通讯作者: 马 林 电话:01066939592,电子邮件:cjr.malin@vip.163.com E-mail:cjr.malin@vip.163.com
  • 基金资助:
    国家自然科学基金(30970816)

Differentiation between Glioma Recurrence and Radiation-induced Brain Injuries Using Perfusion-weighted Magnetic Resonance Imaging

WANG Yu-lin1,LIU Meng-yu1,WANG Yan1,XIAO Hua-feng1,SUN Lu2,ZHANG Jun3,MA Lin1   

  1. 1Department of Radiology,2Department of Pathology,3Department of Neurosurgery,Chinese PLA General Hospital,Beijing 100853,China
  • Received:2013-02-19 Online:2013-08-30 Published:2013-08-30
  • Contact: MA Lin Tel:01066939592,E-mail:cjr.malin@vip.163.com E-mail:cjr.malin@vip.163.com
  • Supported by:
    Supported by the National Natural Sciences Foundation of China(30970816)

摘要: 目的 分析磁共振(MR)灌注成像在鉴别胶质瘤复发与放射性脑损伤中的作用。方法 选取23例脑胶质瘤术后放疗后并出现新强化灶的患者,所有患者均经二次手术病理或随访(随访时间>6个月)证实为胶质瘤复发或放射性脑损伤。23例患者均行常规MR平扫、增强扫描和MR脑灌注成像。灌注成像采用梯度回波-回波平面成像(GRE-EPI)序列,感兴趣区(ROI)放置在横断面T1WI异常强化区域和对侧相对正常的脑白质内,大小为20~40 mm2,每个患者平均测量10次,计算异常强化区与对侧正常区的参数比值,即相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)、达峰时间(rTTP)及团注到达时间(rBAT),采用分组 t 检验比较胶质瘤复发和放射性脑损伤组间各灌注参数。结果 23例患者最终经手术和随访证实有13例胶质瘤复发,10例放射性脑损伤。胶质瘤复发rCBV和rCBF比值分别为3.60±3.86和2.88±2.27,明显高于放射性脑损伤的0.82±0.74(P=0.000)和0.84±0.80(P=0.000);rMTT(P=0.204)、rTTP(P=0.260)和rBAT(P=0.071)的比值在两组间差异没有统计学意义。rCBV和rCBF鉴别诊断为胶质瘤复发或放射性脑损伤的曲线下面积均为0.876。结论 MR灌注成像是鉴别胶质瘤复发和放射性脑损伤的有效方法,rCBV和rCBF比值鉴别诊断界值分别为1.3088和1.1235,可作为可靠的临床指标。

关键词: 神经胶质瘤, 复发, 脑损伤, 放射性, 磁共振成像, 灌注

Abstract: Objective To evaluate the role of perfusion weighted imaging(PWI)in the differentiation between recurrent glioma and radiation-induced brain injuries.Methods Twenty-three patients with previously resected and irradiated glioma,presenting newly developed abnormal enhancement,were included in the study.The final diagnosis was determined either histologically or clinicoradiologically.PWI was obtained with a gradient echo echo-planar-imaging(GRE-EPI)technique.The normalized relative cerebral blood volume(rCBV)ratio[rCBV(abnormal enhancement)/rCBV(contralateral tissue)],relative cerebral blood flow(rCBF)ratio[rCBF(abnormal enhancement)/rCBF(contralateral tissue)],mean transit time(MTT)ratio[MTT(abnormal enhancement)/MTT(contralateral tissue)],time to peak(TTP)ratio[TTP(abnormal enhancement)/TTP(contralateral tissue)],and bolus arrive time(BAT)ratio[BAT(abnormal enhancement)/BAT(contralateral tissue)]were calculated.The regions of interest(ROIs)consisting of 20-40mm2 were placed in the abnormal enhanced areas on postcontrast T1-weighted images.Ten ROIs measurements were performed in each lesion.T test was used to determine whether there was a difference in the rCBV/rCBF/rMTT/rTTP/rBAT ratios between recurrentglioma and iradiated injuries.Significance was set to a P value<0.05.Results Thirteen of the 23 patients were proved recurrent glioma and 10 were proved radiation-induced brain injuries.The rCBV ratio(3.60±3.86 vs.0.82±0.74,P=0.000)and rCBF ratio(2.88±2.27 vs.0.84±0.80,P=0.000)in glioma recurrence were markedly higher than those in radiation injuries.The areas under rCBV and rCBF ROC curve were both 0.8763.rMTT(P=0.204),rTTP(P=0.260),and rBAT(P=0.071)ratios showed no statistical difference between the two groups.Conclusion PWI is an effective technique in distinguishing glioma recurrence from radiation injuries,and the ratios of rCBV and rCBF ratio differential diagnosis of critical value to 1.3088 and 1.1235,respectively,can be used as a reliable clinical indicator.

Key words: glioma, recurrence, brain injuries, radioactivity, magnetic resonance imaging, perfusion