高级别星形细胞肿瘤ASL灌注成像的初步研究

发布时间：2018-03-05 03:22

本文选题：星形细胞肿瘤　切入点：磁共振成像　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分3D-ASL与DSC对脑星形细胞肿瘤血流灌注评估的相关性研究目的：探讨脑星形细胞肿瘤3D-ASL与DSC脑血流量评估的相关性。方法：70例病理证实的脑星形细胞肿瘤，行常规MR平扫、3D-ASL、DSC及增强MR检查，包括毛细胞型星形细胞肿瘤（I级）4例、弥漫性星形细胞肿瘤（II级）28例、间变性星形细胞肿瘤（III级）22例、胶质母细胞瘤（IV级）16例。分别测量肿瘤实性区最大CBF、近瘤周区及镜像区CBF，计算肿瘤实性区及近瘤周区rCBF；应用Spearman相关分析评估两种灌注方法rCBF的相关性。结果：70例脑星形细胞肿瘤3D-ASL和DSC法实性区rCBF（中位数与四分位数间距，下同）分别为3.069与2.151及3.7943与3.825，相关系数r=0.944；两者近瘤周区rCBF分别为0.913与0.576及1.095与0.783，r=0.732。38例HGG组3D-ASL和DSC法实性区rCBF分别为3.662与2.054及4.179与3.468，r=0.918；两者近瘤周区rCBF分别为1.171与0.760及0.974与0.703，r=0.757。32例LGG组3D-ASL和DSC实性区rCBF分别为2.109与2.205及2.591与3.988，r=0.931；两者近瘤周区rCBF分别为0.781与0.438及0.965与0.944，r=0.840。结论：3D-ASL与DSC法测量脑星形细胞肿瘤实性及近瘤周区rCBF值均有很好的相关性，LGG组两个区域rCBF的相关性均优于HGG组，提示3D-ASL对星形细胞肿瘤CBF的评估较可靠。第二部分3D-ASL对环形强化高级别胶质瘤与转移瘤鉴别诊断价值的研究目的：探讨3D-ASL灌注成像鉴别环形强化HGG与脑单发转移瘤的价值。方法：86例病理证实的环形强化HGG48例与脑单发转移瘤38例，行常规MR平扫、3D-ASL灌注成像及MR增强检查，高级别星形细胞肿瘤包括间变性星形细胞瘤22例（III级），胶质母细胞瘤（IV级）26例，，脑内单发转移瘤包括肺癌14例、乳腺癌8例、结肠癌6例、食管癌4例、肾癌6例。分别测量肿瘤实性区最大CBF、瘤周区CBF及镜像区CBF，采用计算肿瘤实性区及瘤周区相对CBF（rCBF），比较两组肿瘤rCBF值之间是否存在差异，采用ROC曲线确定最佳阈值及其鉴别两种肿瘤的敏感度和特异度。结果：HGG与脑内单发转移瘤实性区rCBF值分别为（中位数与四分位数间距）：（3.612，2.100）与（3.123，5.99），两组间差异无统计学意义（P0.05）。HGG与脑单发转移瘤瘤周区rCBF值分别为（中位数与四分位数间距）：（1.101，0.900）与（0.720，0.280），两组之间差异有统计学意义（P0.05），采用ROC曲线分析，当rCBF阈值为0.895时，鉴别两种肿瘤的敏感度及特异度分别为70.8%与84.2%。结论：3D-ASL测量肿瘤实性区rCBF对区分环形强化的HGG与脑单发转移瘤无价值，而近瘤周区的rCBF值有助于鉴别两种肿瘤。
[Abstract]:The correlation between 3D-ASL and DSC in the evaluation of cerebral astrocytic tumor perfusion. Objective: to investigate the correlation between 3 D ASL and DSC cerebral blood flow assessment in brain astrocytoma. Methods 70 cases of pathologically proved brain astrocytoma were examined by conventional Mr 3D-ASLCT DSC and enhanced Mr, including 4 cases of hair cell type astrocytoma, 28 cases of diffuse astrocytoma and 28 cases of diffuse astrocytoma, and 22 cases of anaplastic astrocytoma. In 16 cases of glioblastoma, we measured the maximum CBF in solid tumor area, the surrounding tumor area and mirrored area respectively, calculated the rCBF of tumor solid area and adjacent tumor area, and evaluated the correlation of rCBF by Spearman correlation analysis. Results in 70 cases of brain astrocytoma, 3D-ASL and DSC were used to determine the interval between median and quartile. The correlation coefficient r = 0.944, rCBF near tumor area was 0.913 and 0.576 and 1.095 and 0.783ru 0.732.38 cases of HGG group were 3.662 and 2.054 and 4.179 and 3.468r0.918, respectively. The rCBF of adjacent tumor area was 1.171,0.760 and 0.760, respectively, and that of DSC method was 3.662 and 2.054 and 4.179 and 3.468r0.918, respectively, and that of HGG group was 3.669 and 2.151, and 3.7943 and 3.825, respectively, and the correlation coefficient was 0.944; the rCBF of adjacent tumor area was 0.913 and 0.576, and 1.095 and 0.783.732.38 cases of HGG group, respectively. The rCBF of 3D-ASL and DSC were 2.109,2.205,2.591 and 3.988in 0.757.32 cases of LGG, respectively, and the rCBF of the adjacent tumor area were 0.781 and 0.438 and 0.965 and 0.944 respectively. Conclusion there is a good correlation between the measurement of the density of brain astrocytic tumor by DSC and the measurement of rCBF in the surrounding area by DSC. The correlation of rCBF between the two regions in LGG group is better than that in HGG group, which suggests that 3D-ASL is more reliable in the evaluation of CBF in astrocytoma. The value of 3D-ASL in differential diagnosis of high grade gliomas and metastatic tumors with ring enhancement. Objective: to evaluate the value of 3 D-ASL perfusion imaging in differentiating ring-enhanced HGG from single brain metastases. Methods 86 cases of pathologically proved ring-enhanced HGG48 and 38 cases of single metastatic tumor of brain were examined by conventional plain Mr 3D-ASL perfusion imaging and Mr enhancement. High-grade astrocytoma included 22 cases of anaplastic astrocytoma, 26 cases of glioblastoma grade IV, 14 cases of solitary brain metastases, 8 cases of breast cancer, 6 cases of colon cancer and 4 cases of esophageal carcinoma. In 6 cases of renal cell carcinoma, the largest CBFs in solid tumor area, CBF in surrounding tumor area and CBF in mirror region were measured, and the difference of rCBF values between the two groups was compared by calculating the relative CBFr CBFs of tumor solid area and surrounding tumor area. ROC curve was used to determine the optimal threshold and its sensitivity and specificity. Results the rCBF values of the solid region of the brain with single metastatic tumor were (median to quartile distance: 3.6122.100) and 3.123 (5.99N), respectively. There was no significant difference between the two groups in the rCBF value of the peri-tumor region of single metastatic tumor (median and quartile) (P < 0.05) and the value of rCBF in the perioperative region of single brain metastases was not significantly different between the two groups (median and quartile). The distance between the two groups was 1.101 / 0.900) and 0.720 / 0.280 respectively. The difference between the two groups was statistically significant (P 0.05). The ROC curve was used to analyze the difference between the two groups. When the rCBF threshold was 0.895, the sensitivity and specificity of the two tumors were 70.8% and 84.2, respectively. Conclusion the measurement of rCBF in solid area of tumor by 1: 3D-ASL is of no value in differentiating circular enhanced HGG from single metastatic tumor, while the rCBF value near the peri-tumor area is helpful to differentiate the two types of tumors.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R739.41

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