核磁动脉自旋标记技术在脑神经胶质瘤 分级中的意义

Clinical significance of magnetic resonance arterial spin labeling in grading of brain glioma

摘要:

目的 分析脑神经胶质瘤在核磁动脉自旋标记（ASL）技术中的特征性表现在脑神经胶质瘤分级 中的临床意义。方法 回顾性分析2015 年1 月—2017 年1 月湖北医药学院附属人民医院神经外科经手术病理 证实的84 例脑神经胶质瘤患者。所有患者均接受轴位为T1WI、T2WI、T2 FLAIR、DWI 及3D ASL 扫描序 列，然后进行增强扫描T1WI。3D ASL 扫描采用伪连续式动脉自转标记技术，收集脑血流量（CBF）值数据， 计算其比值，所得值为肿瘤的相对脑血流量（rCBF），分析3D ASL 灌注成像和常规序列图像。结果 84 例患 者均获得了清晰的3D ASL-CBF 灌注图和常规MRI 序列图像。神经胶质瘤的3D ASL-CBF 灌注图显示，患 者均为神经胶质瘤（红色区域成分较多，代表高血流灌注；蓝黑区域代表低血流灌注）。Ⅰ、Ⅱ级，Ⅲ、Ⅳ级 神经胶质瘤所得的TBF/ 对侧白质、TBF/ 对侧灰质和TBF/ 对侧半球比值比较，差异有统计学意义（P <0.05）。 病理结果检测显示，入选84 例患者中有45 例高级脑神经胶质瘤患者，39 例低级脑神经胶质瘤。与病理检测 结果进行比较，3D ASL 诊断的符合率92.86%（78/84）高于常规MRI 的诊断符合率82.14%（69/84）（P <0.05）。 Kappa 值为0.758，一致性较好。结论 3D ASL 能定量反应肿瘤微循环的灌注情况，与常规MRI 序列比较，对 脑神经胶质瘤的定性诊断及术前分级有重要参考价值。

Abstract:

Objective To analyze the magnetic resonance arterial spin labeling (ASL) in grading of brain glioma. Methods A retrospective analysis of 84 patients with glioma confirmed by surgery and pathology in the Department of Neurosurgery of our hospital from January 2015 to January 2017 was made. All patients received axial T1WI, T2WI, T2 FLAIR, DWI and 3D-ASL scans, and then received enhanced scan of T1WI. The 3D ASL scan with pseudo continuous artery self rotation labeling technique was used to calculate cerebral blood flow (CBF) value and relative cerebral blood flow (rCBF) was then transformed. The conventional sequence and 3D ASL perfusion imaging were analyzed. Results A total of 84 patients received conventional MRI image sequences and 3D ASLCBF perfusion map with 3DASL-CBF perfusion map, glioma patients were as follows: red area represented high blood perfusion; blue area represented low perfusion. The ratios of TBF/contralateral white matter, TBF/contralateral gray matter and TBF/contralateral hemisphere in grade I, II and III, IV gliomas were statistically significant (P <0.05). Pathological examination showed that there were 45 cases of advanced glioma and 39 cases of low-grade glioma. Compared with pathological results, the diagnostic accuracy of 3D ASL was 92.86% (78/84), which was higher than that of conventional MRI 82.14% (69/84) (P < 0.05). Kappa value of table was 0.758, the consistency of which was good. Conclusions 3D ASL can quantitatively reflect the perfusion of tumor microcirculation. Compared with routine MRI sequence, it is of important reference value for qualitative diagnosis and preoperative grading of glioma.