定量动态对比增强磁共振成像渗透性与T1灌注多参数联合分析对脑胶质瘤分级的诊断价值

发布时间：2018-12-17 19:33

【摘要】：目的探讨定量动态对比增强磁共振成像(DCE-MRI)渗透性与T1灌注多参数联合分析对脑胶质瘤分级的诊断价值。方法回顾性分析经病理证实的16例高级别脑胶质瘤(HGG)和12例低级别脑胶质瘤(LGG)患者的磁共振平扫和DCE-MRI资料,通过药代动力学模型定量计算肿瘤的渗透性参数及T1灌注模型计算灌注参数,包括转运常数(Ktrans)、部分细胞外血管外间隙容量(ve)、血液回流常数(kep)、血浆容积(vp)和脑血流量(CBF)、脑血容量(CBV)及平均通过时间(MTT)。以t检验比较HGG和LGG定量分析参数的统计学差异,并以受试者工作特征曲线评估渗透性参数(Ktrans值、ve值)、T1灌注参数(CBF值、CBV值)及联合应用灌注和渗透性参数进行脑胶质瘤的分级诊断的敏感性、特异性和曲线下面积。结果 HGG的Ktrans值、ve值、CBF值和CBV值分别为(0.276±0.164)/min、0.486±0.191、(1.755±1.164)ml/(g·min)和(0.204±0.101)ml/g,明显高于LGG的(0.084±0.044)/min、0.274±0.132、(0.761±0.625)ml/(g·min)和(0.115±0.097)ml/g(t值分别为3.934、3.293、2.672和2.338,P均0.05),而HGG的kep值、vp值和MTT值分别为(1.632±1.204)/min、0.114±0.107和(0.128±0.070)min,与LGG的(1.537±1.194)/min、0.055±0.039、(0.145±0.066)min比较差异无统计学意义(t值分别为0.208、1.823和0.668,P均0.05)。单参数中以Ktrans值诊断脑胶质瘤分级的曲线下面积最大,为0.919,取阈值为0.105/min时,诊断高级别脑胶质瘤的敏感性和特异性分别为87.5%和83.3%;而联合运用多参数分级诊断时,以ve-CBF值似然比为0.631时曲线下面积最大,为0.974,敏感性和特异性分别为93.7%和100.0%。结论联合DCE-MRI的渗透性参数与灌注参数能够提高高级别和低级别脑胶质瘤分级的诊断率。
[Abstract]:Objective to evaluate the diagnostic value of quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) permeability and T 1 perfusion multiparameter analysis in glioma grading. Methods the MRI and DCE-MRI data of 16 cases of high grade glioma (HGG) and 12 cases of low grade glioma (LGG) confirmed by pathology were analyzed retrospectively. The permeability parameters of tumor were quantitatively calculated by pharmacokinetic model and perfusion parameters were calculated by T1 perfusion model, including transport constant (Ktrans), partial extracellular intervascular volume (ve), blood return constant (kep), Plasma volume (vp) and cerebral blood flow (CBF), brain blood volume (CBV) and mean transit time (MTT). T test was used to compare the statistical differences between quantitative analysis parameters of HGG and LGG, and permeability parameters (Ktrans, ve), T1 perfusion parameters (CBF) were evaluated by operating characteristic curve. CBV) and the sensitivity, specificity and area under the curve of grading of gliomas using perfusion and permeability parameters. Results the Ktrans value, ve value, CBF value and CBV value of HGG were (0.276 卤0.164) / min,0.486 卤0.191, (1.755 卤1.164) ml/ (g min) and (0.204 卤0.101) ml/g, respectively, which were significantly higher than those of LGG (0.084 卤0.044) / min,. 0.274 卤0.132, (0.761 卤0.625) ml/ (g min) and (0.115 卤0.097) ml/g (t = 3.934, 3.293, 2.672 and 2.338g, respectively), while the kep value of HGG was (0.761 卤0.625) and (0.115 卤0.097) ml/g, respectively. The values of vp and MTT were (1.632 卤1.204) / min,0.114 卤0.107 and (0.128 卤0.070) min, and (1.537 卤1.194) / min,0.055 卤0.039, respectively. (0.145 卤0.066) min had no significant difference (t = 0.208, 1.823 and 0.668, respectively). In the single parameter, the area under the curve of Ktrans was the largest (0.919). When the threshold value was 0.105/min, the sensitivity and specificity of the high-grade gliomas were 87.5% and 83.3%, respectively. The area under the curve of ve-CBF likelihood ratio of 0.631 was the largest (0.974), and the sensitivity and specificity were 93.7% and 100.0%, respectively. Conclusion the combination of permeability parameters and perfusion parameters of DCE-MRI can improve the diagnostic rate of high grade and low grade gliomas.
【作者单位】：浙江大学湖州医院湖州市中心医院放射科;
【基金】：湖州市科技局计划项目(2014GY22)~~
【分类号】：R445.2;R739.41

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