Diagnostic value of diffusion weighted imaging, diffusion tensor imaging and conventional MRI in high-grade glioma
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摘要:
目的探讨扩散加权成像（DWI）、扩散张量成像（DTI）及常规MRI对高级别脑胶质瘤的诊断价值。 方法选取2018年10月~2020年7月医院收治的65例脑胶质瘤患者作为研究对象。手术取病理组织标本，根据病理结果分为高级别脑胶质瘤组和低级别脑胶质瘤组。术前行MRI检查，扫描序列为T1WI、T2WI、DWI、DTI。分析不同级别脑胶质瘤MRI图像，比较不同级别脑胶质瘤的表观弥散系数（ADC）和各向异性分数（FA）值。分析瘤体ADCDWI、ADCDTI、FA诊断高级别脑胶质瘤阈值、敏感度及特异性。 结果65例患者经术后病理检查均确诊为脑胶质瘤，其中低级别脑胶质瘤29例，高级别脑胶质瘤36例；不同级别脑胶质瘤瘤周ADCDWI、ADCDTI和FA值差异无统计学意义（P > 0.05）；不同级别脑胶质瘤瘤体FA值差异无统计学意义（P > 0.05）。高级别脑胶质瘤瘤体ADCDWI和ADCDTI值低于低级别脑胶质瘤（P < 0.05）。ADCDWI、ADCDTI、FA诊断高级别脑胶质瘤的AUC分别为0.775、0.817、0.716。DWI和DTI联合检测诊断高级别脑胶质瘤敏感度和特异度较高，AUC为0.903（P < 0.05）。 结论常规MRI联合DWI、DTI有助于提高脑胶质瘤诊断和病理分级准确度。 Abstract:ObjectiveTo investigate the diagnostic value of diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and conventional MRI in high-grade glioma. MethodsSixty-five patients with glioma in our hospital from October 2018 to July 2020 were selected. According to the pathological results, they were divided into high-grade glioma group and low-grade glioma group. MRI was performed before operation, and the scanning sequences were T1WI, T2WI, DWI and DTI. The MRI images of different grades of gliomas were analyzed, and the apparent dispersion coefficient (ADC) and fractional anisotropy (FA) values of different grades of gliomas were compared. The diagnostic threshold, sensitivity and specificity of ADCDWI, ADCDTI and FA were analyzed. The specificity of ADCDWI, ADCDTI and FA in the diagnosis of high-grade glioma were analyzed. ResultsAll 65 patients were diagnosed as glioma by postoperative pathological examination, including 29 cases of low-grade glioma and 36 cases of high-grade glioma. The difference in ADCDWI, ADCDTI and FA values among different grades of gliomas were not significant(P > 0.05). The difference in FA between different grades of glioma was not significant(P > 0.05). The values of ADCDWI, ADCDTI in high-grade gliomas were significantly lower than those in low-grade gliomas(P < 0.05). The AUC of ADCDWI, ADCDTI and FA were 0.775, 0.817 and 0.716, respectively.The sensitivity and specificity of DWI and DTI in the diagnosis of high-grade gliomas were higher, AUC was 0.903(P < 0.05). ConclusionConventional MRI combined with DWI and DTI can improve the accuracy of diagnosis and pathological grading of glioma. -
图 1 不同级别脑胶质瘤病理结果
A：低级别脑胶质瘤；B：高级别脑胶质瘤.
Figure 1. Pathological results of different grades of gliomas (HE, ×400).
图 2 低级别脑胶质瘤MRI图像
患者男性，49岁，诊断为低级别脑胶质瘤。A： T1WI示左额叶病灶不规则，呈等、稍低信号，内见小囊状低信号；B： T2WI呈等、稍高信号，内见小囊状高信号；C： FA：病变区域FA值均低于镜像对侧脑区，DTT经原始图像后处理获得白质纤维束图像，左额白质纤维束部分破坏、中断；D：病变区域ADC值均高于镜像对侧脑区.
Figure 2. MRI images of low grade gliomas.
图 3 高级别脑胶质瘤MRI图像
患者女性，54岁，诊断为高级别脑胶质瘤。A： T1WI示左额叶团块状异常信号，大部呈等、稍低信号，病灶内见囊变、坏死、出血，囊变呈低信号，坏死呈稍低信号，出血呈高信号；B： T2WI呈等、稍高信号，病灶内见囊变、坏死、出血、水肿，囊变呈高信号、坏死呈稍高信号、出血呈低信号、水肿为病灶边缘环形稍高信号；C： FA：病变区域FA值明显低于镜像对侧脑区，病变区域ADC值高于镜像对侧脑区。DTT经原始图像后处理获得白质纤维束图像，左侧脑室体旁白质纤维束受压变形，局部中断，结构不整；D：病变区域ADC值均高于镜像对侧脑区.
Figure 3. MRI image of high grade gliomas
图 4 瘤体ADCDWI、ADCDTI、FA诊断高级别脑胶质瘤的ROC曲线
Figure 4. ROC curve of ADCDWI, ADCDTI and FA in the diagnosis of high grade glioma.
表 1 不同级别脑胶质瘤ADC和FA值比较
Table 1. Comparison of ADC and FA values in different grades of gliomas (Mean±SD)
脑胶质瘤级别 瘤体 瘤周 ADCDWI
（×10-9mm2/s）ADCDTI
（×10-9mm2/s）FA ADCDWI
（×10-9mm2/s）ADCDTI
（×10-9mm2/s）FA 低级别（n=29） 1.53±0.24 2.12±0.31 0.43±0.15 1.38±0.16 1.36±0.33 0.18±0.05 高级别（n=36） 1.41±0.23 1.46±0.28 0.39±0.13 1.41±0.18 1.49±0.32 0.16±0.04 t 2.051 9.006 1.151 0.711 1.600 1.792 P 0.044 ＜0.01 0.254 0.480 0.115 0.078 ADC： 表观弥散系数； FA： 各向异性分数 
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表 2 瘤体ADCDWI、ADCDTI、FA诊断高级别脑胶质瘤阈值、敏感度及特异性分析
Table 2. Analysis of threshold, sensitivity and specificity of ADCDWI, ADCDTI and FA in the diagnosis of high-grade glioma
指标 分级阈值 敏感度（%） 特异性（%） P AUC 瘤体ADCDWI（×10-9mm2/s） 0.93 84.6 65.5 0.000 0.775 瘤体ADCDTI（×10-9mm2/s） 0.78 76.9 79.3 0.000 0.817 瘤体FA 0.34 69.2 58.6 0.006 0.716 瘤体ADCDWI+ADCDTI+FA - 80.8 86.2 0.000 0.903
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