摘要
目的:探讨MR动态磁敏感对比增强(DSC)灌注技术在胶质瘤复发和放射性脑损伤鉴别诊断中的应用价值。方法:28例胶质瘤术后、放疗后并出现新强化灶的患者,经再次手术或随访证实为胶质瘤复发或放射性脑损伤。所有患者均行常规MR平扫、增强及DSC灌注成像,测量病灶强化区域的相对脑血容量(r CBV)及相对脑血流量(r CBF),并同时取对侧正常白质的r CBV和r CBF,分别相比后得到相对比值,比较胶质瘤复发和放射性脑损伤各灌注参数比值,并采用ROC曲线评价r CBV和r CBF相对比值对二者进行鉴别的敏感性和特异性。结果:胶质瘤复发异常强化灶的r CBV和r CBF相对比值分别为2.78±1.01和1.89±0.82,明显高于放射性脑损伤的0.76±0.42和0.47±0.31,差异有统计学意义(P<0.05)。ROC曲线分析显示r CBV相对比值≥1.88时,诊断胶质瘤复发的特异性为100.0%,r CBV相对比值≤0.62时诊断放射性脑损伤敏感性为100.0%;r CBV比值取1.88为阈值来鉴别胶质瘤复发和放射性脑损伤时,敏感性、特异性和准确性分别为94.4%、100.0%、96.4%。r CBF相对比值≥1.96时,诊断胶质瘤复发特异度为100.0%,r CBF相对比值≤0.45时诊断放射性脑损伤敏感性为100.0%;r CBF相对比值取0.85为阈值来鉴别胶质瘤复发和放射性脑损伤时,敏感性、特异性和准确性分别为94.4%、90.0%、92.8%。结论:磁共振DSC灌注成像有助于对胶质瘤复发和放射性脑损伤进行鉴别。
Objective：To explore the value of dynamic susceptibility-weighted contrast-enhanced（DSC）MR imaging in differentiating glioma recurrence and cerebral radiation injury. Methods：Twenty-eight patients who had cerebral gliomas were treated with radiotherapy after operation,presenting newly abnormal enhancement. All the patients underwent routine MR,DSC perfusion. The value of r CBV and r CBF in the new enhanced lesion and the opposite white matter were measured and analyzed. Receiver operating characteristic（ROC）curve was used to find the best classification threshold,and then calculating its sensitivity,specificity and accuracy. Results：The relative r CBV and r CBF value in the recurrent lesion were 2.78 ± 1.01 and 1.89 ± 0.82,respectively,while in the radiation injured lesion were 0.76 ± 0.42 and 0.47 ± 0.31,respectively（all P〈0.05）. Analysis of ROC curve showed that：if the relative r CBV value≥1.88,the diagnosis specificity of recurrent glioma was 100.0%;if the relative r CBV value≤0.62,the diagnosis sensitivity of radiation injuries was 100.0%. The threshold of the relative r CBV value was 1.88,and the differential diagnosis sensibility,specificity,and accuracy were 94.4%,100.0% and 96.4%,respectively. If the relative r CBF value≥1.96,the diagnosis specificity of recurrent glioma was 100.0%;if the relative r CBF value≤0.45,the diagnosis sensitivity of radiation injuries was 100.0%. The threshold of the relative r CBF value was 0.85,and the differential diagnosis sensibility,specificity,and accuracy were 94.4%,90.0% and 92.8%,respectively. Conclusion：DSC MRI is helpful to differentiate glioma recurrence and cerebral radiation injury.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2018年第1期20-24,共5页
Journal of Nanjing Medical University(Natural Sciences)
基金
国家自然科学基金(81302185)
关键词
胶质瘤
复发
放射性脑损伤
磁共振灌注加权成像
动态磁敏感对比增强
gliomas
recurrence
cerebral radiation injury
magnetic resonance perfusion-weighted imaging
dynamic susceptibilitycontrast-enhanced
