动脉自旋标记在胶质瘤分级的应用
发布时间：2018-07-31 14:38
【摘要】：目的：颅内胶质瘤（Gliomas）的发病具有明显上升的趋势，手术切除肿瘤是治疗本病的主要方法，但能否完全切除是手术的关键所在，在术前对胶质瘤能够做出正确的分级，可以为术中及术后的治疗提供指导性的意义。在胶质瘤分级中对比研究动脉自旋标记（ASL）法和动态磁敏感对比增强（DSC）方法的特点，用来探讨是否能够为患者带来解决过敏及价格昂贵的新方法。由于ASL法只有一个灌注参数CBF，通过增加延迟时间（PLD）来探讨是否能够为分级提供更准确的依据。 方法：收集于2012年3月至2014年1月间在吉林大学白求恩第一医院住院的患者并且高度怀疑为胶质瘤的患者为此次研究的对象，在经得患者同意后行常规MRI平扫基础上加行ASL1.5s、ASL2.5s及DSC检查，最后行增强检查。术后经病理证实为胶质瘤的患者为34例，女性患者有14例，男性患者有20例，年龄在32-67岁之间。主要临床表现为嗜睡、颅内压增高症状、肢体障碍以及癫痫等。把原始数据在GE工作站上进行后处理，ASL法获得rCBF图，DSC法获得rCBF图。在所需要的灌注图中，结合MRI增强检查，感兴趣区（region of interest,ROI）设置在肿瘤实质处血流最大层面，而得到肿瘤的TBFmax，瘤周水肿的CBF，并且还要取相同层面对侧的脑白质、脑灰质及对侧半球的脑血流量。分别取3个值后再取其平均值。之后计算TBFmax/对侧白质CBF、TBFmax/对侧灰质CBF及TBFmax/对侧半球CBF的值。所有患者均在吉林大学白求恩第一医院神经外科手术，获取肿瘤标本后由资深病理专家确定肿瘤类型及分级。 所有数据均采用SPSS18.0统计软件完成。首先采用方差齐性检验，配对t检验用于ASL和DSC两种技术、ASL1.5s和ASL2.5s之间对比研究，两独立样本t检验用于高、低级别胶质瘤之间对比研究。数值结果以均数±标准差（±s）表示。以P＜0.01为差异有统计学意义。 结果：在34例脑胶质瘤患者中，ASL技术与DSC法的灌注结果中，肿瘤的两种灌注方法均获得了一致的灌注结果，肿瘤血流灌注/对侧灰质的脑血流量（TBF/对侧灰质CBF）、肿瘤血流灌注/对侧白质的脑血流量（TBF/对侧白质CBF）、肿瘤血流灌注/对侧半球的脑血流量（TBF/对侧半球CBF），，在这两种技术之间差异均无明显统计学意义（P＞0.05）。 在DSC法中，（肿瘤、瘤周水肿）血流灌注/（对侧灰质、白质、对侧半球）的脑血流量，在这两种级别间差异具有统计学意义（P值＜0.01）；在ASL法中，高级别与低级别的肿瘤血流灌注/（对侧灰质、白质、对侧半球）的脑血流量，在这两种级别间差异具有统计学意义（P值＜0.01）。 在ASL1.5s与ASL2.5s中，（肿瘤、瘤周水肿）血流灌注/（对侧灰质、白质、对侧半球）的脑血流量，在这两种技术之间差异均无明显统计学意义（P＞0.05）。 胶质瘤的不同级别在ASL和DSC灌注中，血流灌注呈现不同的表现，低、稍高及等的血流灌注为低级别组胶质瘤，明显的高血流灌注为高级别组肿瘤实质的表现，肿瘤内的钙化坏死为无灌注。高级别胶质瘤内可见不同的灌注。且在本组胶质瘤患者的灌注情况有4例与其强化方式不同，经术后病理证实，肿瘤的分级与灌注的结果保持一致，证明强化程度并不能真正代表肿瘤的分级情况。 结论：1.ASL与DSC方法具有一致的灌注结果，由于ASL的无创、便捷，所以在肿瘤分级的诊断ASL可以值得推广。2.在ASL与DSC方法中，高级别胶质瘤的最大血流量大于低级别胶质瘤的最大血流量，ASL和DSC均可用于胶质瘤分级中的诊断。3.瘤周水肿的血流量值可以反应肿瘤的侵润程度，可以为外科手术提供重要的辅助作用。4.ASL延迟其动脉到达时间差异不具有统计学意义，所以改变ASL的动脉到达时间对肿瘤的分级意义不大。
[Abstract]:Objective: the incidence of intracranial glioma (Gliomas) is obviously rising. Surgical resection of the tumor is the main method for the treatment of this disease. But the key to the operation is whether complete resection is the key. The correct classification of glioma before operation can provide a guiding significance for intraoperative and postoperative treatment. The comparison of glioma classification is compared. The characteristics of the arterial spin labeling (ASL) method and the dynamic magnetic sensitivity contrast enhancement (DSC) method are studied to explore the ability to bring new methods for patients to be sensitive and expensive. Because the ASL method has only one perfusion parameter, CBF, the delay time (PLD) is added to explore the possibility of providing a more accurate basis for the classification.
Methods: the patients who were hospitalized at Bethune's First Hospital of Jilin University from March 2012 to January 2014 were highly suspected of being glioma, and ASL1.5s, ASL2.5s and DSC examinations were performed on the basis of conventional MRI scan after the patient's consent, and the postoperatively confirmed by pathology as glia. There were 34 cases of tumor, 14 female patients, 20 male patients and 32-67 years old. The main clinical manifestations were somnolence, increased intracranial pressure, limb disorders, and epilepsy. The original data were processed on the GE workstation, the rCBF map was obtained by the ASL method, and the rCBF map was obtained by the DSC method. In the required perfusion map, the MRI enhancement examination was combined in the perfusion map needed. Region of interest (ROI) is set at the maximum blood flow level in the parenchyma of the tumor, and the TBFmax of the tumor, the CBF of the peritumoral edema, and the cerebral white matter in the same layer, the cerebral gray matter and the cerebral blood flow in the contralateral hemisphere. The average value is taken after 3 values respectively. Then the TBFmax/ pair white matter CBF and the TBFmax/ opposite side are calculated. The value of gray matter CBF and TBFmax/ to CBF in the lateral hemisphere. All patients were operated in Department of Neurosurgery at Bethune First Hospital of Jilin University. After obtaining the tumor specimens, the tumor type and classification were determined by the senior pathologist.
All data were completed by SPSS18.0 statistical software. First, variance homogeneity test was used, paired t test was used for two techniques of ASL and DSC, comparative study between ASL1.5s and ASL2.5s, and two independent sample t test was used for comparative study between high and low grade gliomas. Numerical results were represented by mean mean standard deviation (+ s). The difference was statistically significant with P < 0.01. Learning meaning.
Results: in 34 patients with glioma, both ASL and DSC perfusion results, the two perfusion methods of the tumor were all consistent with the perfusion results, the tumor blood perfusion / the cerebral blood flow of the side gray matter (TBF/ against the side gray CBF), the tumor blood perfusion / contralateral white matter cerebral blood flow (TBF/ contralateral white matter CBF), the tumor blood perfusion / contralateral side Hemispherical cerebral blood flow (TBF/ contralateral hemisphere CBF) showed no significant difference between the two techniques (P > 0.05).
In the DSC method, the cerebral blood flow of (tumor, Zhou Shuizhong) perfusion / (to the side gray, white matter, to the lateral hemisphere) has a statistically significant difference between the two levels (P < 0.01); in the ASL method, the cerebral blood flow of high and low grade tumor blood flow / (to the side gray, white matter, the contralateral hemisphere) is different between the two levels. There were statistical significance (P value < 0.01).
In ASL1.5s and ASL2.5s, the blood flow of (tumor, tumor Zhou Shuizhong) blood flow / (to the side gray matter, white matter, the opposite hemisphere) had no significant difference between the two techniques (P > 0.05).
The different grades of glioma were in ASL and DSC perfusion, and the blood flow perfusion presented different manifestations. The low, slightly high, and other blood perfusion were low grade glioma. The high blood flow perfusion was the manifestation of the tumor substance in the advanced group. The calcified necrosis was instilled in the tumor. Different perfusion was found in the high grade glioma. The patient's perfusion was different from that of 4 patients. The tumor's classification was consistent with the result of perfusion after operation. It proved that the degree of enhancement did not really represent the classification of the tumor.
Conclusion: the 1.ASL and DSC methods have consistent perfusion results. Because of the noninvasive and convenient ASL, the diagnosis of ASL in the tumor classification is worth promoting.2. in the ASL and DSC methods. The maximum blood flow of high grade glioma is greater than that of low grade glioma. ASL and DSC can be used for the diagnosis of.3. peritematous edema in glioma classification. The value of blood flow can reflect the degree of tumor invasion, which can provide an important auxiliary effect for surgical operation..4.ASL delayed the difference of arrival time of the artery without statistical significance, so it is not significant to change the arrival time of the ASL artery to the tumor classification.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41;R445.2
本文编号：2155900
[Abstract]:Objective: the incidence of intracranial glioma (Gliomas) is obviously rising. Surgical resection of the tumor is the main method for the treatment of this disease. But the key to the operation is whether complete resection is the key. The correct classification of glioma before operation can provide a guiding significance for intraoperative and postoperative treatment. The comparison of glioma classification is compared. The characteristics of the arterial spin labeling (ASL) method and the dynamic magnetic sensitivity contrast enhancement (DSC) method are studied to explore the ability to bring new methods for patients to be sensitive and expensive. Because the ASL method has only one perfusion parameter, CBF, the delay time (PLD) is added to explore the possibility of providing a more accurate basis for the classification.
Methods: the patients who were hospitalized at Bethune's First Hospital of Jilin University from March 2012 to January 2014 were highly suspected of being glioma, and ASL1.5s, ASL2.5s and DSC examinations were performed on the basis of conventional MRI scan after the patient's consent, and the postoperatively confirmed by pathology as glia. There were 34 cases of tumor, 14 female patients, 20 male patients and 32-67 years old. The main clinical manifestations were somnolence, increased intracranial pressure, limb disorders, and epilepsy. The original data were processed on the GE workstation, the rCBF map was obtained by the ASL method, and the rCBF map was obtained by the DSC method. In the required perfusion map, the MRI enhancement examination was combined in the perfusion map needed. Region of interest (ROI) is set at the maximum blood flow level in the parenchyma of the tumor, and the TBFmax of the tumor, the CBF of the peritumoral edema, and the cerebral white matter in the same layer, the cerebral gray matter and the cerebral blood flow in the contralateral hemisphere. The average value is taken after 3 values respectively. Then the TBFmax/ pair white matter CBF and the TBFmax/ opposite side are calculated. The value of gray matter CBF and TBFmax/ to CBF in the lateral hemisphere. All patients were operated in Department of Neurosurgery at Bethune First Hospital of Jilin University. After obtaining the tumor specimens, the tumor type and classification were determined by the senior pathologist.
All data were completed by SPSS18.0 statistical software. First, variance homogeneity test was used, paired t test was used for two techniques of ASL and DSC, comparative study between ASL1.5s and ASL2.5s, and two independent sample t test was used for comparative study between high and low grade gliomas. Numerical results were represented by mean mean standard deviation (+ s). The difference was statistically significant with P < 0.01. Learning meaning.
Results: in 34 patients with glioma, both ASL and DSC perfusion results, the two perfusion methods of the tumor were all consistent with the perfusion results, the tumor blood perfusion / the cerebral blood flow of the side gray matter (TBF/ against the side gray CBF), the tumor blood perfusion / contralateral white matter cerebral blood flow (TBF/ contralateral white matter CBF), the tumor blood perfusion / contralateral side Hemispherical cerebral blood flow (TBF/ contralateral hemisphere CBF) showed no significant difference between the two techniques (P > 0.05).
In the DSC method, the cerebral blood flow of (tumor, Zhou Shuizhong) perfusion / (to the side gray, white matter, to the lateral hemisphere) has a statistically significant difference between the two levels (P < 0.01); in the ASL method, the cerebral blood flow of high and low grade tumor blood flow / (to the side gray, white matter, the contralateral hemisphere) is different between the two levels. There were statistical significance (P value < 0.01).
In ASL1.5s and ASL2.5s, the blood flow of (tumor, tumor Zhou Shuizhong) blood flow / (to the side gray matter, white matter, the opposite hemisphere) had no significant difference between the two techniques (P > 0.05).
The different grades of glioma were in ASL and DSC perfusion, and the blood flow perfusion presented different manifestations. The low, slightly high, and other blood perfusion were low grade glioma. The high blood flow perfusion was the manifestation of the tumor substance in the advanced group. The calcified necrosis was instilled in the tumor. Different perfusion was found in the high grade glioma. The patient's perfusion was different from that of 4 patients. The tumor's classification was consistent with the result of perfusion after operation. It proved that the degree of enhancement did not really represent the classification of the tumor.
Conclusion: the 1.ASL and DSC methods have consistent perfusion results. Because of the noninvasive and convenient ASL, the diagnosis of ASL in the tumor classification is worth promoting.2. in the ASL and DSC methods. The maximum blood flow of high grade glioma is greater than that of low grade glioma. ASL and DSC can be used for the diagnosis of.3. peritematous edema in glioma classification. The value of blood flow can reflect the degree of tumor invasion, which can provide an important auxiliary effect for surgical operation..4.ASL delayed the difference of arrival time of the artery without statistical significance, so it is not significant to change the arrival time of the ASL artery to the tumor classification.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41;R445.2
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