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目的探讨多b值体素不相干运动扩散加权磁共振成像(intravoxel incoherent motion MR imaging,IVIM-MRI)在胶质瘤术前分级诊断中的应用价值。方法纳入本院经手术病理确诊脑胶质瘤患者40例(低级别18例,高级别22例),术前行常规MR平扫、增强及多b值IVIM序列扫描,IVIM图像经后处理工作站分析,分别测量肿瘤实质区、瘤周区及对侧正常半卵圆中心的ADCstandard、慢速扩散系数D(slow ADC)、快速扩散系数D*(fast ADC)以及灌注分数f(fraction of fast ADC)值。所得数据经统计软件进行组间比较并与病理分级进行相关性分析。结果 40例胶质瘤患者肿瘤实质区、瘤周区的ADCstandard、D、D*值均明显高于对侧半卵圆中心;肿瘤实质区D、D*值高于瘤周区,差异均有统计学意义(P<0.05)。高级别肿瘤实质区ADCstandard值[(1.09±0.22)vs(1.48±0.32)×10-3mm2/s,t=4.391,P<0.05]、D值[(0.78±0.17)vs(1.21±0.23)×10-3mm2/s,t=6.236,P<0.05]显著低于低级别者;高级别者肿瘤实质区D*值[(32.65±9.91)vs(17.12±7.74)×10-3mm2/s,t=-5.290,P<0.05]、f值[(0.47±0.08)vs(0.29±0.07),t=-7.177,P<0.05]显著高于低级别者。通过Pearson相关性分析发现高、低级别肿瘤分级与ADCstandard、D值呈负相关,与D*、f值呈正相关;根据高、低级别胶质瘤肿瘤实质区的ADCstandard、D、D*、f值绘制ROC曲线,其曲线下面积及诊断阈值分别为ADCstandard(0.851,1.23×10-3mm2/s)、D(0.939,0.92×10-3mm2/s)、D*(0.899,20.6×10-3mm2/s)、f(0.957,0.36)。结论多b值IVIM-MRI所得ADCstandard、D、D*、f值在高、低级别胶质瘤中存在统计学差异,有利于术前安全无创地检测胶质瘤扩散及灌注信息判断其级别。
Objective To investigate the value of multi-b value voxel in incoherent motion MR imaging (IVIM-MRI) in preoperative classification of gliomas. Methods Forty cases (18 cases of low grade and 22 cases of high grade) with glioma confirmed by surgery and pathology were enrolled in our hospital. Normal MR scan, enhanced and multi-b value IVIM scan were performed preoperatively. IVIM image post-processing workstation The ADCstandard, slow ADC, fast ADC, fast ADC, and fraction of fast ADC were measured respectively in the tumor parenchyma, peritumoral region and contralateral normal hemilivius. )value. The data obtained by the statistical software for comparison between groups and pathological grade correlation analysis. Results The ADCstandard, D, D * values in the tumor parenchyma and peritumoral region in 40 glioma patients were significantly higher than those in the contralateral hemilicle; the D and D * values in the parenchyma were higher than those in the peritumorous area Statistical significance (P <0.05). The ADCstandard value of the high grade tumor was [(1.09 ± 0.22) vs (1.48 ± 0.32) × 10-3mm2 / s, t = 4.391, P <0.05] and the value of D was (0.78 ± 0.17) × (1.21 ± 0.23) × (32.65 ± 9.91) vs (17.12 ± 7.74) × 10-3mm2 / s, t (t = 6.236, P <0.05) were significantly lower than those in the low- = -5.290, P <0.05], f value [(0.47 ± 0.08) vs (0.29 ± 0.07), t = -7.177, P <0.05]. According to Pearson correlation analysis, the grade of high and low grade tumors was negatively correlated with ADCstandard and D values, and positively correlated with D * and f values. According to ADCstandard, D, D *, f ROC curves were plotted. The area under the curve and the diagnostic threshold were ADCstandard (0.851,1.23 × 10-3mm2 / s), D (0.939,0.92 × 10-3mm2 / s), D * (0.899,20.6 × 10-3mm2 /s),f(0.957,0.36). Conclusions ADCstandard, D, D *, f values obtained from multi-b value IVIM-MRI have statistical significance in high and low grade gliomas, which is conducive to preoperative noninvasive detection of glioma proliferation and perfusion information to determine the grade.