3D-ASL技术在高级别脑胶质瘤术后复发诊断与鉴别诊断中的应用
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摘要
目的探讨3D-ASL技术在高级别脑胶质瘤术后复发诊断与鉴别诊断中价值。方法选取52例高级别脑胶质瘤术后放疗后在MRI随访出现术区异常强化病灶的患者,其中经过二次手术或随访确诊肿瘤复发者34例为A组,确诊放射性脑损伤者18例为B组。2组患者均行常规MRI平扫、增强及3D-ASL检查;测量3D-ASL血流灌注图像中的病灶实质部分最大血流量值(CBFmax)和对侧镜像区、对侧白质、灰质的CBFmax值,所得数值标准化后做统计学分析。分别通过常规MRI和常规MRI联合3D-ASL技术做出诊断,将2种方法的诊断符合率行统计学比较。结果平均最大相对脑血流量(r CBFmax)比值在两组患者之间的差异有统计学意义;联合应用3DASL技术对胶质瘤复发的诊断正确率有明显提高,两种诊断方法差异有统计学意义。结论 3D-ASL技术安全无创,无需注射造影剂,可以用于胶质瘤复发与放射损伤的鉴别,常规MRI联合3D-ASL有助于提高胶质瘤复发的诊断正确率。
Objective To investigate the application of 3 D arterial spin labeling(3 D-ASL) in the differential diagnosis of recurrence in postoperative high-grade glioma. Methods 52 patients with high-grade glioma who underwent postoperative MRI follow-up with abnormal enhanced lesions were selected. Group A included 34 patients who were confirmed by re-operation or followup for tumor recurrence. Group B included 18 patients with radioactive brain injury. All cases underwent routine MRI,MR enhancement and 3 DASL. The maximal cerebral blood flow of solid regions of tumor(CBFmax) and the cerebral blood flow of opposite mirror region,opposite white matter,opposite grey matter and opposite hemisphere were measured on maps. The numerical values were standardized and statistically analyzed. The diagnostic coincidence rate of the two methods with conventional MRI and conventional MRI combined with 3 D-ASL was compared. Results There were significant differences between CBFmax of two groups. The diagnostic accuracy of glioma recurrence using MRI combined with 3 D-ASL was significantly improved,and there was significant difference between them. Conclusion 3 D-ASL technology is safe and uninvasive,and without contrast agent. It is a useful technology in the differential diagnosis of glioma recurrence and radiation injury. MRI combined with 3 D-ASL can help to improve the diagnostic accuracy of glioma recurrence.
Objective To investigate the application of 3 D arterial spin labeling(3 D-ASL) in the differential diagnosis of recurrence in postoperative high-grade glioma. Methods 52 patients with high-grade glioma who underwent postoperative MRI follow-up with abnormal enhanced lesions were selected. Group A included 34 patients who were confirmed by re-operation or followup for tumor recurrence. Group B included 18 patients with radioactive brain injury. All cases underwent routine MRI,MR enhancement and 3 DASL. The maximal cerebral blood flow of solid regions of tumor(CBFmax) and the cerebral blood flow of opposite mirror region,opposite white matter,opposite grey matter and opposite hemisphere were measured on maps. The numerical values were standardized and statistically analyzed. The diagnostic coincidence rate of the two methods with conventional MRI and conventional MRI combined with 3 D-ASL was compared. Results There were significant differences between CBFmax of two groups. The diagnostic accuracy of glioma recurrence using MRI combined with 3 D-ASL was significantly improved,and there was significant difference between them. Conclusion 3 D-ASL technology is safe and uninvasive,and without contrast agent. It is a useful technology in the differential diagnosis of glioma recurrence and radiation injury. MRI combined with 3 D-ASL can help to improve the diagnostic accuracy of glioma recurrence.
引文
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[4] Arvinda HR,Kesavadas C,Sarma PS,et al. Glioma grading:sensitivity,specificity,positive and negative predictive values of diffusion and perfusion imaging[J]. Neuro Oncol,2009,94(1):87-96.
[5] Folkman J. Tumor angiogenesis:therapeutic implications[J].NEngl J Med,1971,285(21):1182-1186.
[6] Batra A,Tripathi RP,Singh AK. Perfusion magnetic resonance imaging and magnetic resonance spectroscopy of cerebral gliomas showing imperceptible contrast enhancement on conventional magnetic resonance imaging[J]. Australas Radiol,2004,48(3):324-332.
[7] Detre JA,Leigh JS,Williams DS,et al. Perfusion imaging[J].Magn Reson Med,1992,23(1):37-45.
[8] Wu WC,Fernandez-Seara M,Detre JA,et al. A theoretical and experimental investigation of the tagging efficiency of pseudo continuous arterial spin labeling[J]. Magn Reson Med,2007,58(5):1020-1027.
[9] Amukotuwa SA,Yu C,Zaharchuk G. 3D Pseudocontinuous arterial spin labeling in routine clinical practice:a review of clinically significant artifacts[J]. Journal of Magnetic Resonance Imaging,2015,43(1):11.