MRI评分在星形细胞起源肿瘤诊断中的应用

目的观察星形细胞起源肿瘤患者的MRI表现,探讨MRI评分与病理学分级之间的相关性。方法选择经手术病理证实的幕上星形细胞起源肿瘤患者44例,其中星形细胞瘤9例、间变性星形细胞瘤14例及多形性胶质母细胞瘤21例,手术后进行MRI评分。评分标准包括肿瘤是否越过中线、有无水肿、不均质性、出血、边界清晰、囊变或坏死、血管流空效应、强化程度和强化的不均质性等9项指标。结果MRI评分随肿瘤病理分级的提高而增加,星形细胞瘤患者的不均质性、水肿、边界清晰、血管流空效应、强化程度和强化的不均质性等6项指标均低于间变性星形细胞瘤和多形性胶质母细胞瘤,其差异具有显著性意义(均P<0.05);而间变性星形细胞瘤与多形性胶质母细胞瘤之间9项指标相比,仅不均质性和强化程度2项差异有显著性意义(P<0.05)。结论MRI评分对选择星形细胞起源肿瘤的治疗方法及判断患者预后具有重要临床参考价值。

Application of MRI score in diagnosis of astrocytic tumors

Objective To study the MRI patterns of patients with astrocytic tumors and the correlation between MRI score and the pathological grades of the tumor. Methods A total of 44 patients with supratentorial astrocytic tumors identified by operation and pathological examination were enrolled in the study, including astrocytoma (n=9), anaplastic astrocytoma (n=14) and glioblastoma multiforme (n=21), and evaluated MRI score postoperatively. Nine parameters of MRI score were included ig. heterogeneity (HET), cyst formation or necrosis (CN), hemorrhage (HEM), crossing the mid-line (CM), edema (EM), border definition (BD), flow void (FV), degree of contrast enhancement (CE-D) and heterogeneity of contrast enhancement (CE-HET). Results The scores increased along with the increasing of pathological grades. There was significantly lower scores in astrocytomas than those in anaplastic astrocytoma and glioblastoma multiforme (P < 0.05 for each) in six (HET, EM, CE-D, CE-HET, BD and FV) of the nine parameters;whereas only HET and CE-D showed significantly higher in glioblastoma multiforme than in anaplastic astrocytomas (P < 0.05). Conclusion It is rather easy to differentiate the astrocytoma from higher grade astrocytomas (anaplastic astrocytoma and glioblastoma multiforme)by MRI score and also for differentiating anaplastic astrocytoma from glioblastoma. Thus the application of MRI score is helpful in selection of therapeutic approaches and evaluation prognosis for patients with astrocytic tumors.