DSC-MRI和IVIM在鉴别高级别脑胶质瘤术后复发和放射性脑损伤的初步研究

目的探讨磁共振动态磁敏感对比增强(dynamic susceptibility weighted contrast enhanced,DSC-MRI)和体素不相干运动扩散加权成像(intravoxelincoherentmotion,IVIM)在鉴别高级别脑胶质瘤术后复发及放射性脑损伤的应用价值。材料与方法收集高级别脑胶质瘤术后切除+同步放化疗后行MRI检查的32例患者,且MRI影像检查中出现新增异常强化灶。根据二次手术或随访结果分为肿瘤复发组(22例)及放射性脑损伤组(10例)。测量两组患者的相对脑血容量(relative cerebral blood volume,rCBV)、纯扩散系数(true diffusion coefficient,D)、灌注相关扩散系数(perfusion related diffusion coefficient,D^*)、灌注分数(perfusionfraction,f)等参数。采用独立样本t检验分析两组间的差异,进行受试者工作特征(receiver operating characteristic,ROC)曲线的绘制并计算曲线下面积、敏感度、特异度;采用Pearson检验分析参数间相关性。结果复发组rCBV值、D^*值、f值均高于放射性脑损伤组,差异有统计学意义(P<0.05),复发组D值低于放射性脑损伤组,差异有统计学意义(P<0.05),ROC曲线分析,rCBV值、D值、D^*值、f值曲线下面积为0.832、0.709、0.814、0.780,灵敏度分别为72.7%、86.4%、81.8%、95.5%,特异度分别为90.0%、50.0%、80.0%、50.0%。DSC-MRI联合IVIM诊断时,曲线下面积为0.891,灵敏度及特异度分别为81.8%、90.0%;D^*值(r=0.542,P<0.05)、f值(r=0.352,P<0.05)与rCBV值成正相关。结论DSC-MRI联合IVIM在胶质瘤复发和放射性脑损伤的鉴别诊断中具有重要的临床应用价值,且rCBV值与D^*、f值之间有一定的相关性。

Preliminary study of DSC-MRI and IVIM in differentiating postoperative recurrence and radiation brain injury of high-grade glioma

Objective:To investigate the dynamic susceptibility weighted contrast enhanced(DSC-MRI)and intravoxel incoherent motion(IVIM)of magnetic resonance imaging in differentiating high-grade glioma recurrence and radiation brain injury.Materials and Methods:Thirty-two patients with high-grade gliomas who underwent postoperative resection and concurrent chemoradiotherapy and MRI were collected,and new abnormally enhanced lesions appeared in the MRI imaging.According to the results of the second operation or followup,they were divided into tumor recurrence group(n=22)and radiation brain injury group(n=10).Measure the relative cerebral blood volume(rCBV),pure diffusion coefficient(D),perfusion related diffusion coefficient(D^*),and perfusion fraction(f)and other parameters.The independent sample t test was used to analyze the differences between the two groups,and the receiver operating characteristic(ROC)curve was plotted and the area under the curve,sensitivity,and specificity were calculated;and the correlation between the parameters was analyzed using the Pearson test.Results:The rCBV value,D^*value,and f value of the relapse group were higher than those of the radiation brain injury group,and the difference was statistically significant(P<0.05).The D value of the relapse group was lower than that of the radiation brain injury group,and the difference was statistically significant(P<0.05),ROC curve analysis,rCBV value,D value,D^*value,area under the f value curve are 0.832,0.709,0.814,0.780,sensitivity is 72.7%,86.4%,81.8%,95.5%,specificity is 90.0%,50.0%,80.0%,50.0%.When DSC-MRI combined with IVIM was diagnosed,the area under the curve was 0.891,and the sensitivity and specificity were 81.8%and 90.0%,respectively;the D^*value(r=0.542,P<0.05),and the f-value(r=0.352,P<0.05),there is a positive correlation with the rCBV value.Conclusions:DSC-MRI combined with IVIM has important clinical application value in the differential diagnosis of glioma recurrence and radiation brain damage,and there is a certain correlation between rCBV value and D^*,f value.