磁共振成像在预测脑胶质瘤分子病理学分型中的应用研究

发布时间：2018-02-15 06:08

  本文关键词： 磁共振成像 磁共振弥散加权成像 异柠檬酸脱氢酶1基因 突变　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价常规磁共振成像(Magnetic Resonance Imaging,MRI)、磁共振弥散加权成像(Diffusion Weighted Imaging,DWI)在无创性预测脑胶质瘤分子病理学分型的价值。方法:回顾性分析105例经组织病理学证实的成人幕上脑胶质瘤患者术前常规MRI资料和DWI资料。观察患者的临床资料(性别、年龄)和常规MRI资料(病灶位置、数目、中线结构、均质性、囊变坏死、出血、边界、水肿、强化、最大径)以及DWI资料(minimal Apparent Diffusion Coefficient,mADC;ratio of minimal ADC,rmADC;ADC in the paralesional edema area,eADC;ratio of edema ADC,reADC)。根据2007版世界卫生组织中枢神经系统肿瘤(World Health Organization classification of tumors of the Central Nervous System,WHO CNS)分级方法将脑胶质瘤分成低级别(WHOⅡ级)(39例)组和高级别(WHOⅢ级和WHOⅣ级)(66例)组,再根据免疫组织化学检查和基因测序检查结果确定异柠檬酸脱氢酶1(Isocitrate Dehydrogenase1)基因状态。低级别脑胶质瘤中有27例IDH1基因突变型病例,高级别脑胶质瘤中有21例IDH1基因突变型病例。分析低、高级别IDH1基因突变型亚组与野生型亚组在所研究临床资料和影像学指标中的差异。结果:1、临床资料:高级别IDH1基因突变型脑胶质瘤患者平均年龄(42.57±8.85岁)比野生型(51.67±11.68岁)小。2、常规MRI资料:IDH1基因突变型脑胶质瘤更易发生于额叶;高级别IDH1基因野生型脑胶质瘤存在脑内多发浸润;中线结构和病灶最大径、肿瘤内部囊变坏死可以作为低级别脑胶质瘤IDH1基因突变与否的鉴别点;病灶水肿程度及强化程度可以作为判断低、高级别脑胶质瘤IDH1基因状态的重要影像学指标。3、DWI资料:mADC值及rmADC值在低级别、高级别IDH1突变型及野生型脑胶质瘤间存在统计学差异。低级别脑胶质瘤中,mADC值及rmADC值的ROC曲线下面积为0.819、0.823,当mADC值、rmADC值分别取1.265×10-3mm2/s、0.283时,可以达到敏感性及特异性最佳组合;高级别脑胶质瘤中,mADC值及rmADC值的ROC曲线下面积为0.872、0.869,当mADC值、rmADC值分别取0.094×10-3mm2/s、0.389时,可以达到敏感性及特异性最佳组合。结论:1、临床资料中,年龄有助于判断高级别脑胶质瘤IDH1基因突变情况;2、常规磁共振资料中,肿瘤好发部位、中线结构和最大径、边界、内部信号、强化及水肿程度有助于无创性判断脑胶质瘤IDH1基因状态;3、mADC值、rmADC值对于低、高级别脑胶质瘤IDH1基因状态的判断具有十分重要的参考价值。
[Abstract]:Objective: to evaluate the value of conventional magnetic Resonance imaging (MRI) and diffusion-weighted Weighted imaging (DWI) in noninvasive prediction of molecular pathological classification of gliomas. Methods: a retrospective analysis of 105 cases of adult tentorium confirmed by histopathology was made. Routine MRI and DWI data of patients with upper glioma before operation. Clinical data of patients were observed. Age) and conventional MRI data (location, number, midline structure, homogeneity, cystic necrosis, hemorrhage, boundary, edema, enhancement), Maximum diameter) and DWI data of minimum Apparent Diffusion Apparent ratio of minimal Apparent rmADCA in the paralesional edema ADCA of edema ADCA. According to the 2007 World Health Organization classification of tumors of the Central Nervous system, gliomas were classified into low grade and WHO 鈪，

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