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目的探讨磁共振灌注加权成像(PWI)与扩散张量成像(DTI)在脑胶质瘤分级诊断中的应用价值。方法选择在湖州市中心医院治疗的脑胶质瘤患者78例,其中低级别35例,高级别43例。测量平均扩散系数(ADC)、各向异性分数(FA)、相对平均扩散系数(rADC)、相对各向异性分数(rFA)、局部脑血流量(rCBF)、局部脑血容量(rCBV)、相对局部脑血流量(rrCBF)、相对局部脑血容量(rrCBV)值,应用SPSS软件对肿瘤不同部位以及高低级别胶质瘤间各个指标进行差异性比较,并根据受试者操作特征(ROC)曲线确定诊断阈值和分析其敏感度及特异性。结果 77例脑胶质瘤瘤体的ADC、rCBF、rCBV值分别大于相应瘤周、大于相应对侧白质的测量值;瘤体FA值小于瘤周以及对侧白质。差异均有统计学意义(P<0.05);高级别胶质瘤瘤体及瘤周的rrCBV、rrCBF分别大于低级别胶质瘤(P<0.05),高级别胶质瘤瘤体的rADC值小于低级别胶质瘤(P<0.05);ROC曲线得出rrCBF和rrCBV的曲线下面积分别为95.4%以及90.2%,相应的分级诊断的敏感度和特异度分别为87.0%、95.2%与85.3%、89.2%。结论磁共振灌注加权成像与扩散张量成像可以用于胶质瘤术前分级诊断,其中,rrCBF是诊断价值最大的指标。
Objective To investigate the value of perfusion weighted imaging (PWI) and diffusion tensor imaging (DTI) in the differential diagnosis of gliomas. Methods 78 cases of glioma patients were treated in Central Hospital of Huzhou, including 35 cases of low grade and 43 cases of high grade. Mean diffusivity (ADC), anisotropic fraction (FA), relative average diffusivity (rADC), relative anisotropy fraction (rFA), regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) Local cerebral blood flow (rrCBF), relative regional cerebral blood volume (rrCBV) values were compared using SPSS software between different parts of the tumor and high and low grade glioma between the various indicators were compared, and according to the operating characteristics of patients (ROC) curve Determine the diagnostic threshold and analyze its sensitivity and specificity. Results The ADC, rCBF and rCBV values of 77 gliomas were significantly higher than those of the corresponding peritumoral and contralateral white matter, respectively. The FA values of the tumors were smaller than those of the peritumoral and contralateral white matter. (P <0.05). The rrCBV and rrCBF in high-grade gliomas and peritumoral neoplasms were significantly higher than those in low-grade gliomas (P <0.05), and the high-grade gliomas (P <0.05). The ROC curves showed that the area under the curve of rrCBF and rrCBV were 95.4% and 90.2%, respectively. The sensitivity and specificity of corresponding classification were 87.0%, 95.2% and 85.3% , 89.2%. Conclusion MR perfusion weighted imaging and diffusion tensor imaging can be used for the preoperative grading diagnosis of gliomas. Among them, rrCBF is the most valuable diagnostic value.