磁共振灌注加权成像与弥散加权成像在脑胶质瘤分级诊断中的应用

目的:探讨磁共振灌注加权成像(perfusion weighted imaging,PWI)与弥散加权成像(diffusion weighted imaging,DWI)在脑胶质瘤分级诊断中的应用价值。方法:选取2012年1月-2017年6月在我院就诊并经病理证实为脑胶质瘤患者100例,其中高、低级别胶质瘤患者各44、56例。对所有患者行PWI、DWI检查,比较肿瘤不同区域表观扩散系数(apparent diffusion coefficient,ADC)、局部脑血流量(regional cerebral blood flow,rCBF),不同级别肿瘤实质区、瘤周水肿区rADC、rrCBF,根据ROC曲线分析rADC、rrCBF对不同级别胶质瘤的诊断阈值、敏感性、特异性。结果:与对侧相应正常脑实质比较,瘤周水肿区及肿瘤实质区ADC、rCBF均显著升高(P0.05);与瘤周水肿区比较,肿瘤实质区ADC、rCBF均显著升高(P0.05)。高级别肿瘤实质区rADC显著低于低级别肿瘤实质区(P0.05),rrCBF显著高于肿瘤实质区(P0.05)。高级别瘤周水肿区与低级别瘤周水肿区rADC间无显著差异(P0.05),高级别瘤周水肿区rrCBF显著高于低级别瘤周水肿区(P0.05)。在对高、低级别脑胶质瘤的分级中,rADC、rrCBF的曲线下面积(under the receiver operating characteristic curve,AUC)分别为0.957、0.978,均0.9。rADC诊断不同分级胶质瘤的敏感度是90.12%,特异度是95.26%,诊断阈值是13.12;rrCBF诊断不同分级胶质瘤的敏感度是92.31%,特异度是98.57%,诊断阈值是2.62。rADC与rrCBF诊断不同分级胶质瘤敏感度、特异度间无显著差异(P0.05)。结论:PWI、DWI能够为脑胶质瘤的分级诊断提供参考依据。

Application of Perfusion Weighted Imaging and Diffusion Weighted Imaging in the Grading Diagnosis of Glioma

ABSTRACT Objective: To explore the value of perfusion weighted imaging and diffusion weighted imaging in grading diagnosis of glioma. Methods: Selected 100 glioma patients in our hospital from January 2012 to June 2017. Pathologically confirmed high and low grade glioma patients each have 44, 56 cases. All patients underwent PWI, DWI examination. ADC and rCBF of different regions of glioma were compared. The rADC and rrCBF of different grades of tumor parenchyma and peritumoral edema of glioma patients were compared. According to ROC curve, the diagnostic threshold, sensitivity and specificity of rADC and rrCBF in different grades of gliomas were analyzed. Results: Compared with corresponding normal brain parenchyma, ADC and rCBF in peritumoral edema and tumor parenchyma were significantly increased (P<0.05). Compared with the peritumoral edema area, ADC and rCBF in the parenchyma of the tumor were significantly increased (P<0.05). The rADC of the high grade tumor was significantly lower than that of the low grade tumor (P<0.05) and rrCBF was significantly higher than that of the tumor (P <0.05). There was no significant difference between high-grade peritumoral edema and low-grade peritumoral edema rADC (P>0.05). The rrCBF in high-grade peritumoral edema was significantly higher than that in low-grade peritumoral edema (P<0.05). According to ROC curve analysis, the area under the curve of rADC and rrCBF under the classification of high and low grade gliomas were 0.957, 0.978. The sensitivity, specificity and threshold value of rADC in diagnosing different grade glioma were 90.12 %, 95.26 % and 13.12, respectively. The sensitivity, specificity and threshold value of rrCBF in diagnosing different grade glioma were 92.31 %, 98.57 % and 2.62 respectively. There was no significant difference between rADC and rrCBF in diagnosis of gliomas with different grading (P<0.05). Conclusion: PWI, DWI can provide a reference for the grading diagnosis of gliomas.