CAJ | 학술논문

目的评价采用MR灌注加权成像(PWI)测量胶质瘤微血管管径的有效性及准确性,并初步探讨胶质瘤血管管径指数(VSI)在胶质瘤分级中的作用.方法搜集脑胶质瘤患者28例,其中低级别肿瘤(WHOⅡ级)9例、高级别肿瘤19例[间变性胶质瘤(WHOⅢ级)6例和胶质母细胞瘤(WHOⅣ级)13例].所有患者行MR梯度回波-自旋回波动态磁敏感对比增强灌注序列扫描,得到VSI彩图,用热点法测量肿瘤最大灌注区微血管管径大小.将VSI值与组织学测量的微血管管腔的内径(包括长径及短径)行Pearson相关性分析,对不同级别胶质瘤的VSI值和组织学管径行单因素方差分析.应用ROC曲线评估VSI值鉴别高、低级别胶质瘤的价值.结果 PWI测量肿瘤VSI最大值为(130.6±58.9)μm,平均值为(106.2±46.5) μm;组织学测量微血管长径为(34.2±13.6) μm,短径为(24.0±11.9)μm.VSI平均值与短径(r=0.808)、长径(r=0.805),VSI最大值与短径(r=0.777)、长径(r=0.801)间均呈明显正相关(P值均＜0.01).Ⅱ、Ⅲ和Ⅳ级胶质瘤的VSI平均值分别为(44.0±19.1)、(112.3±24.0)、(138.8±23.2) μm,长径分别为(18.9±5.1)、(33.3±10.1)、(43.5± 10.2) μan,短径分别为(10.0±2.4)、(21.9±8.3)、(33.7±7.2)μm,不同级别间差异均有统计学意义(F值分别为45.33、18.81、33.45,P值均＜0.01).ROC曲线分析显示VSI平均值取临界值81.1 μm,VSI最大值取临界值109.0 μm时,其鉴别高、低级别胶质瘤的敏感度及特异度均可达100％.结论 VSI和组织学方法评估血管管径大小有很好的一致性,VSI方法可术前定量评估胶质瘤微血管结构的改变,将有可能更准确预测胶质瘤分级和预后.
목적 평개채용MR관주가권성상(PWI)측량효질류미혈관관경적유효성급준학성,병초보탐토효질류혈관관경지수(VSI)재효질류분급중적작용.방법 수집뇌효질류환자28례,기중저급별종류(WHOⅡ급)9례、고급별종류19례[간변성효질류(WHOⅢ급)6례화효질모세포류(WHOⅣ급)13례].소유환자행MR제도회파-자선회파동태자민감대비증강관주서렬소묘,득도VSI채도,용열점법측량종류최대관주구미혈관관경대소.장VSI치여조직학측량적미혈관관강적내경(포괄장경급단경)행Pearson상관성분석,대불동급별효질류적VSI치화조직학관경행단인소방차분석.응용ROC곡선평고VSI치감별고、저급별효질류적개치.결과 PWI측량종류VSI최대치위(130.6±58.9)μm,평균치위(106.2±46.5) μm;조직학측량미혈관장경위(34.2±13.6) μm,단경위(24.0±11.9)μm.VSI평균치여단경(r=0.808)、장경(r=0.805),VSI최대치여단경(r=0.777)、장경(r=0.801)간균정명현정상관(P치균＜0.01).Ⅱ、Ⅲ화Ⅳ급효질류적VSI평균치분별위(44.0±19.1)、(112.3±24.0)、(138.8±23.2) μm,장경분별위(18.9±5.1)、(33.3±10.1)、(43.5± 10.2) μan,단경분별위(10.0±2.4)、(21.9±8.3)、(33.7±7.2)μm,불동급별간차이균유통계학의의(F치분별위45.33、18.81、33.45,P치균＜0.01).ROC곡선분석현시VSI평균치취림계치81.1 μm,VSI최대치취림계치109.0 μm시,기감별고、저급별효질류적민감도급특이도균가체100％.결론 VSI화조직학방법평고혈관관경대소유흔호적일치성,VSI방법가술전정량평고효질류미혈관결구적개변,장유가능경준학예측효질류분급화예후.
Objective To assess the validity and accuracy of the vessel size index(VSI) derived from magnetic resonance perfusion imaging (MR-PWI) and to explore the correlation between VSI and glioma grading.Methods Twenty-eight patients with glioma confirmed by pathology (WHO Ⅱ in 9 cases,WHO Ⅲ in 6 cases,and WHO Ⅳ in 13 cases) undertook MRI on 1.5 T scanner.VSI maps were generated from multi gradient-echo spin-echo sequence of MRI dynamic susceptibility contrast perfusion imaging.Hot spot method was used to measure vessel size in the area of the highest perfusion.Cerebral microvascular caliber was measured by immunohistochemistry ex vivo.Pearson correlation analysis was used to assess the correlation between the MRI findings and histology.One-way ANOVA was used to compare vessel size and VSI value among different grades of gliomas.ROC analysis was used to evaluate VSI values in distinguishing high-grade glioma from low-grade.Results MR-VSI showed that the maximal value of microvascular diameters was (130.6± 58.9) μm,average value was (106.2±46.5) μm.Histology showed that the long diameter of glioma microvessels was (34.2± 13.6) μm,short diameter was (24.0± 11.9)μm.There was strong correlation between VSIMRI average values and short diameters or long diameters(r=0.808,0.805,respectively; P＜0.01).And also there was positive correlation between VSI maximal values and short diameters or long diameters(r=0.777,0.801,respectively; P＜ 0.01).The VSI average values for grade Ⅱ,Ⅲ or Ⅳ glioma were (44.0± 19.1),(112.3±24.0),(138.8±23.2)μm,respectively.The long diameters were (18.93±5.11),(33.27±10.14),(43.54±10.16)μm,and short diameters were (10.0±2.4),(21.9±8.3),(33.7± 7.2) μm,respectively.All revealed significant difference(F=45.33,18.81,33.45,P＜0.01).ROC analysis revealed the optimal cutoff value of 81.1 μm (mean VSI) and 109.0 μm (maximal VSI) for distinguishing the high-grade gliomas from low-grade,the sensitivity and specificity were both 100％.Conclusions MR VSI has a good quantitative agreement with histological microvessel diameters.MR-VSI can be used to preoperatively evaluate the changes of vascular structure of gliomas,and may become a more accurate way to grade glioma and predict patients' prognosis.