Clinical value of DCE-MR in astrocytoma diagnosis and differential diagnosis
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摘要:
目的 探讨定量磁共振动态增强在星形细胞瘤诊断及鉴别诊断中的应用价值。 方法 60名怀疑脑内肿瘤的患者（男32名，女28名）使用GE Signa HDxT 3.0T（Milwaukee）进行定量磁共振动态增强检查，对比剂使用非离子型钆对比剂钆双胺，剂量0.2 mL/kg，注射流速3 mL/s。所有患者的扫描原始图像均使用OK软件自动选取感兴趣区，每个病变测量3个层面：中心层面、中心两旁各1/2层面处，取其平均值，计算其容量转移常数（Ktrans）、速率常数（Kep）及血管外细胞外间隙容积比（Ve）；测量时应尽量避开血管及伪影。 结果 35名患者发现颅内有肿瘤，其中28名进行了手术并取病理活检，星形细胞瘤14名，脑膜瘤3名，室管膜瘤3名，转移瘤4名，颅咽管瘤2名，听神经瘤2名。病理结果显示14例星形细胞瘤3例Ⅰ级、4例为Ⅱ级，4例为Ⅲ级、3例为Ⅳ级，定量参数Ktrans值、Kep值、Ve值在Ⅲ级与Ⅳ级的高级别星形细胞瘤均明显高于Ⅰ级与Ⅱ级的低级别星形细胞瘤（P<0.05）；Ⅰ级与Ⅱ级，Ⅲ级与Ⅳ级星形细胞瘤之间Ktrans值、Ve值无统计学差异（P>0.05）。 结论 磁共振定量参数Ktrans值、Kep值、Ve值可用于术前区分低级别与高级别星形细胞瘤，也可用于术后评估复发可能性，对于术前进行无创性评价肿瘤病理分级具有临床指导价值。 Abstract:Objective To explore the clinical value of DCE-MR in astrocytoma diagnosis and differential diagnosis. Methods The magnetic resonance examination were performed in 60 cases of patients (Male 32, Female 28) with suspend of brain tumors by GE Signa HDxT 3.0T (GE medical system, Milwaukee) after the administration of Omniscan at the flow rate of 3 mL/s, 0.1 mmol/kg. The ROI was automatically selected by the OK software, three slides were measured. The measurement was trying to avoid blood vessels and artifacts. The Ktrans, Kep and Ve were calculated and the average value was taken. Results Tumor was found in 35 patients, 28 of them underwent surgery and biopsy, 14 astrocytomas, 3 meningiomas, 3 ependymomas, 4 metastases, 2 craniopharyngiomas and 2 acoustic neuroma. The pathological results showed that 3 of 14 astrocytomas were grade I, 4 were grade II, 4 were grade III and 3 were grade IV. Both values of high grade gliomas include grade Ⅲ and Ⅳ were significantly higher than that of low grade gliomas include gradeⅠ and Ⅱ (P<0.05). There was no statistically difference of the parameters of Ktrans and Ve values between grades Ⅰ with Ⅱ and grade Ⅲ with Ⅳ (P>0.05). Conclusion Quantitative DCE-MR parameters Ktrans, Kep and Ve value can be used to distinguish low grade and high grade astrocytoma, and evaluate the possibility of recurrence, plays an important role in discriminate different grade intracranial tumors in a preoperative noninvasive way. -
表 1 Ⅰ级与Ⅲ级胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅰ级(n = 3) Ⅲ级(n = 4) P Ktrans(min-1) 0.121±0.068 0.285±0.051 <0.05 Ve 0.069±0.031 0.239±0.078 <0.05 Kep(min-1) 1.754±0.475 1.193±0.331 <0.05 
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表 2 Ⅰ级与Ⅳ级胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅰ级(n = 3) Ⅳ级(n = 3) P Ktrans(min-1) 0.121±0.068 0.328±0.121 <0.05 Ve 0.069±0.031 0.242±0.132 <0.05 Kep(min-1) 1.754±0.475 1.355±0.261 <0.05
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表 3 Ⅱ级与Ⅲ级胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅱ级(n = 4) Ⅲ级(n = 4) P Ktrans(min-1) 0.182±0.051 0.285±0.051 <0.05 Ve 0.115±0.090 0.239±0.078 <0.05 Kep(min-1) 1.583±0.434 1.193±0.331 <0.05
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表 4 Ⅱ级与Ⅳ级胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅱ级(n = 4) Ⅳ级(n = 3) P Ktrans(min-1) 0.182±0.051 0.328±0.121 <0.05 Ve 0.115±0.090 0.242±0.132 <0.05 Kep(min-1) 1.583±0.434 1.355±0.261 <0.05
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表 5 低级别胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅰ级(n = 3) Ⅱ级(n = 4) P Ktrans(min-1) 0.121±0.068 0.182±0.051 >0.05 Ve 0.069±0.031 0.115±0.090 >0.05 Kep(min-1) 1.754±0.475 1.583±0.434 >0.05
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表 6 高级别胶质瘤的Ktrans值、Ve值、Kep值比较
参数 Ⅲ级(n = 4) Ⅳ级(n = 3) P Ktrans(min-1) 0.285±0.051 0.328±0.121 >0.05 Ve 0.239±0.078 0.242±0.132 >0.05 Kep(min-1) 1.193±0.331 1.355±0.261 >0.05
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