Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2013, Vol. 35 ›› Issue (4): 416-421.doi: 10.3881/j.issn.1000-503X.2013.04.011

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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)

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