動脈自旋標記在膠質(zhì)瘤分級的應(yīng)用
發(fā)布時間：2018-07-31 14:38
【摘要】：目的：顱內(nèi)膠質(zhì)瘤（Gliomas）的發(fā)病具有明顯上升的趨勢，手術(shù)切除腫瘤是治療本病的主要方法，但能否完全切除是手術(shù)的關(guān)鍵所在，在術(shù)前對膠質(zhì)瘤能夠做出正確的分級，可以為術(shù)中及術(shù)后的治療提供指導(dǎo)性的意義。在膠質(zhì)瘤分級中對比研究動脈自旋標記（ASL）法和動態(tài)磁敏感對比增強（DSC）方法的特點，用來探討是否能夠為患者帶來解決過敏及價格昂貴的新方法。由于ASL法只有一個灌注參數(shù)CBF，通過增加延遲時間（PLD）來探討是否能夠為分級提供更準確的依據(jù)。 方法：收集于2012年3月至2014年1月間在吉林大學(xué)白求恩第一醫(yī)院住院的患者并且高度懷疑為膠質(zhì)瘤的患者為此次研究的對象，在經(jīng)得患者同意后行常規(guī)MRI平掃基礎(chǔ)上加行ASL1.5s、ASL2.5s及DSC檢查，最后行增強檢查。術(shù)后經(jīng)病理證實為膠質(zhì)瘤的患者為34例，女性患者有14例，男性患者有20例，年齡在32-67歲之間。主要臨床表現(xiàn)為嗜睡、顱內(nèi)壓增高癥狀、肢體障礙以及癲癇等。把原始數(shù)據(jù)在GE工作站上進行后處理，ASL法獲得rCBF圖，DSC法獲得rCBF圖。在所需要的灌注圖中，結(jié)合MRI增強檢查，感興趣區(qū)（region of interest,ROI）設(shè)置在腫瘤實質(zhì)處血流最大層面，而得到腫瘤的TBFmax，瘤周水腫的CBF，并且還要取相同層面對側(cè)的腦白質(zhì)、腦灰質(zhì)及對側(cè)半球的腦血流量。分別取3個值后再取其平均值。之后計算TBFmax/對側(cè)白質(zhì)CBF、TBFmax/對側(cè)灰質(zhì)CBF及TBFmax/對側(cè)半球CBF的值。所有患者均在吉林大學(xué)白求恩第一醫(yī)院神經(jīng)外科手術(shù)，獲取腫瘤標本后由資深病理專家確定腫瘤類型及分級。 所有數(shù)據(jù)均采用SPSS18.0統(tǒng)計軟件完成。首先采用方差齊性檢驗，配對t檢驗用于ASL和DSC兩種技術(shù)、ASL1.5s和ASL2.5s之間對比研究，兩獨立樣本t檢驗用于高、低級別膠質(zhì)瘤之間對比研究。數(shù)值結(jié)果以均數(shù)±標準差（±s）表示。以P＜0.01為差異有統(tǒng)計學(xué)意義。 結(jié)果：在34例腦膠質(zhì)瘤患者中，ASL技術(shù)與DSC法的灌注結(jié)果中，腫瘤的兩種灌注方法均獲得了一致的灌注結(jié)果，腫瘤血流灌注/對側(cè)灰質(zhì)的腦血流量（TBF/對側(cè)灰質(zhì)CBF）、腫瘤血流灌注/對側(cè)白質(zhì)的腦血流量（TBF/對側(cè)白質(zhì)CBF）、腫瘤血流灌注/對側(cè)半球的腦血流量（TBF/對側(cè)半球CBF），，在這兩種技術(shù)之間差異均無明顯統(tǒng)計學(xué)意義（P＞0.05）。 在DSC法中，（腫瘤、瘤周水腫）血流灌注/（對側(cè)灰質(zhì)、白質(zhì)、對側(cè)半球）的腦血流量，在這兩種級別間差異具有統(tǒng)計學(xué)意義（P值＜0.01）；在ASL法中，高級別與低級別的腫瘤血流灌注/（對側(cè)灰質(zhì)、白質(zhì)、對側(cè)半球）的腦血流量，在這兩種級別間差異具有統(tǒng)計學(xué)意義（P值＜0.01）。 在ASL1.5s與ASL2.5s中，（腫瘤、瘤周水腫）血流灌注/（對側(cè)灰質(zhì)、白質(zhì)、對側(cè)半球）的腦血流量，在這兩種技術(shù)之間差異均無明顯統(tǒng)計學(xué)意義（P＞0.05）。 膠質(zhì)瘤的不同級別在ASL和DSC灌注中，血流灌注呈現(xiàn)不同的表現(xiàn)，低、稍高及等的血流灌注為低級別組膠質(zhì)瘤，明顯的高血流灌注為高級別組腫瘤實質(zhì)的表現(xiàn)，腫瘤內(nèi)的鈣化壞死為無灌注。高級別膠質(zhì)瘤內(nèi)可見不同的灌注。且在本組膠質(zhì)瘤患者的灌注情況有4例與其強化方式不同，經(jīng)術(shù)后病理證實，腫瘤的分級與灌注的結(jié)果保持一致，證明強化程度并不能真正代表腫瘤的分級情況。 結(jié)論：1.ASL與DSC方法具有一致的灌注結(jié)果，由于ASL的無創(chuàng)、便捷，所以在腫瘤分級的診斷ASL可以值得推廣。2.在ASL與DSC方法中，高級別膠質(zhì)瘤的最大血流量大于低級別膠質(zhì)瘤的最大血流量，ASL和DSC均可用于膠質(zhì)瘤分級中的診斷。3.瘤周水腫的血流量值可以反應(yīng)腫瘤的侵潤程度，可以為外科手術(shù)提供重要的輔助作用。4.ASL延遲其動脈到達時間差異不具有統(tǒng)計學(xué)意義，所以改變ASL的動脈到達時間對腫瘤的分級意義不大。
[Abstract]:Objective: the incidence of intracranial glioma (Gliomas) is obviously rising. Surgical resection of the tumor is the main method for the treatment of this disease. But the key to the operation is whether complete resection is the key. The correct classification of glioma before operation can provide a guiding significance for intraoperative and postoperative treatment. The comparison of glioma classification is compared. The characteristics of the arterial spin labeling (ASL) method and the dynamic magnetic sensitivity contrast enhancement (DSC) method are studied to explore the ability to bring new methods for patients to be sensitive and expensive. Because the ASL method has only one perfusion parameter, CBF, the delay time (PLD) is added to explore the possibility of providing a more accurate basis for the classification.
Methods: the patients who were hospitalized at Bethune's First Hospital of Jilin University from March 2012 to January 2014 were highly suspected of being glioma, and ASL1.5s, ASL2.5s and DSC examinations were performed on the basis of conventional MRI scan after the patient's consent, and the postoperatively confirmed by pathology as glia. There were 34 cases of tumor, 14 female patients, 20 male patients and 32-67 years old. The main clinical manifestations were somnolence, increased intracranial pressure, limb disorders, and epilepsy. The original data were processed on the GE workstation, the rCBF map was obtained by the ASL method, and the rCBF map was obtained by the DSC method. In the required perfusion map, the MRI enhancement examination was combined in the perfusion map needed. Region of interest (ROI) is set at the maximum blood flow level in the parenchyma of the tumor, and the TBFmax of the tumor, the CBF of the peritumoral edema, and the cerebral white matter in the same layer, the cerebral gray matter and the cerebral blood flow in the contralateral hemisphere. The average value is taken after 3 values respectively. Then the TBFmax/ pair white matter CBF and the TBFmax/ opposite side are calculated. The value of gray matter CBF and TBFmax/ to CBF in the lateral hemisphere. All patients were operated in Department of Neurosurgery at Bethune First Hospital of Jilin University. After obtaining the tumor specimens, the tumor type and classification were determined by the senior pathologist.
All data were completed by SPSS18.0 statistical software. First, variance homogeneity test was used, paired t test was used for two techniques of ASL and DSC, comparative study between ASL1.5s and ASL2.5s, and two independent sample t test was used for comparative study between high and low grade gliomas. Numerical results were represented by mean mean standard deviation (+ s). The difference was statistically significant with P < 0.01. Learning meaning.
Results: in 34 patients with glioma, both ASL and DSC perfusion results, the two perfusion methods of the tumor were all consistent with the perfusion results, the tumor blood perfusion / the cerebral blood flow of the side gray matter (TBF/ against the side gray CBF), the tumor blood perfusion / contralateral white matter cerebral blood flow (TBF/ contralateral white matter CBF), the tumor blood perfusion / contralateral side Hemispherical cerebral blood flow (TBF/ contralateral hemisphere CBF) showed no significant difference between the two techniques (P > 0.05).
In the DSC method, the cerebral blood flow of (tumor, Zhou Shuizhong) perfusion / (to the side gray, white matter, to the lateral hemisphere) has a statistically significant difference between the two levels (P < 0.01); in the ASL method, the cerebral blood flow of high and low grade tumor blood flow / (to the side gray, white matter, the contralateral hemisphere) is different between the two levels. There were statistical significance (P value < 0.01).
In ASL1.5s and ASL2.5s, the blood flow of (tumor, tumor Zhou Shuizhong) blood flow / (to the side gray matter, white matter, the opposite hemisphere) had no significant difference between the two techniques (P > 0.05).
The different grades of glioma were in ASL and DSC perfusion, and the blood flow perfusion presented different manifestations. The low, slightly high, and other blood perfusion were low grade glioma. The high blood flow perfusion was the manifestation of the tumor substance in the advanced group. The calcified necrosis was instilled in the tumor. Different perfusion was found in the high grade glioma. The patient's perfusion was different from that of 4 patients. The tumor's classification was consistent with the result of perfusion after operation. It proved that the degree of enhancement did not really represent the classification of the tumor.
Conclusion: the 1.ASL and DSC methods have consistent perfusion results. Because of the noninvasive and convenient ASL, the diagnosis of ASL in the tumor classification is worth promoting.2. in the ASL and DSC methods. The maximum blood flow of high grade glioma is greater than that of low grade glioma. ASL and DSC can be used for the diagnosis of.3. peritematous edema in glioma classification. The value of blood flow can reflect the degree of tumor invasion, which can provide an important auxiliary effect for surgical operation..4.ASL delayed the difference of arrival time of the artery without statistical significance, so it is not significant to change the arrival time of the ASL artery to the tumor classification.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41;R445.2
本文編號：2155900
[Abstract]:Objective: the incidence of intracranial glioma (Gliomas) is obviously rising. Surgical resection of the tumor is the main method for the treatment of this disease. But the key to the operation is whether complete resection is the key. The correct classification of glioma before operation can provide a guiding significance for intraoperative and postoperative treatment. The comparison of glioma classification is compared. The characteristics of the arterial spin labeling (ASL) method and the dynamic magnetic sensitivity contrast enhancement (DSC) method are studied to explore the ability to bring new methods for patients to be sensitive and expensive. Because the ASL method has only one perfusion parameter, CBF, the delay time (PLD) is added to explore the possibility of providing a more accurate basis for the classification.
Methods: the patients who were hospitalized at Bethune's First Hospital of Jilin University from March 2012 to January 2014 were highly suspected of being glioma, and ASL1.5s, ASL2.5s and DSC examinations were performed on the basis of conventional MRI scan after the patient's consent, and the postoperatively confirmed by pathology as glia. There were 34 cases of tumor, 14 female patients, 20 male patients and 32-67 years old. The main clinical manifestations were somnolence, increased intracranial pressure, limb disorders, and epilepsy. The original data were processed on the GE workstation, the rCBF map was obtained by the ASL method, and the rCBF map was obtained by the DSC method. In the required perfusion map, the MRI enhancement examination was combined in the perfusion map needed. Region of interest (ROI) is set at the maximum blood flow level in the parenchyma of the tumor, and the TBFmax of the tumor, the CBF of the peritumoral edema, and the cerebral white matter in the same layer, the cerebral gray matter and the cerebral blood flow in the contralateral hemisphere. The average value is taken after 3 values respectively. Then the TBFmax/ pair white matter CBF and the TBFmax/ opposite side are calculated. The value of gray matter CBF and TBFmax/ to CBF in the lateral hemisphere. All patients were operated in Department of Neurosurgery at Bethune First Hospital of Jilin University. After obtaining the tumor specimens, the tumor type and classification were determined by the senior pathologist.
All data were completed by SPSS18.0 statistical software. First, variance homogeneity test was used, paired t test was used for two techniques of ASL and DSC, comparative study between ASL1.5s and ASL2.5s, and two independent sample t test was used for comparative study between high and low grade gliomas. Numerical results were represented by mean mean standard deviation (+ s). The difference was statistically significant with P < 0.01. Learning meaning.
Results: in 34 patients with glioma, both ASL and DSC perfusion results, the two perfusion methods of the tumor were all consistent with the perfusion results, the tumor blood perfusion / the cerebral blood flow of the side gray matter (TBF/ against the side gray CBF), the tumor blood perfusion / contralateral white matter cerebral blood flow (TBF/ contralateral white matter CBF), the tumor blood perfusion / contralateral side Hemispherical cerebral blood flow (TBF/ contralateral hemisphere CBF) showed no significant difference between the two techniques (P > 0.05).
In the DSC method, the cerebral blood flow of (tumor, Zhou Shuizhong) perfusion / (to the side gray, white matter, to the lateral hemisphere) has a statistically significant difference between the two levels (P < 0.01); in the ASL method, the cerebral blood flow of high and low grade tumor blood flow / (to the side gray, white matter, the contralateral hemisphere) is different between the two levels. There were statistical significance (P value < 0.01).
In ASL1.5s and ASL2.5s, the blood flow of (tumor, tumor Zhou Shuizhong) blood flow / (to the side gray matter, white matter, the opposite hemisphere) had no significant difference between the two techniques (P > 0.05).
The different grades of glioma were in ASL and DSC perfusion, and the blood flow perfusion presented different manifestations. The low, slightly high, and other blood perfusion were low grade glioma. The high blood flow perfusion was the manifestation of the tumor substance in the advanced group. The calcified necrosis was instilled in the tumor. Different perfusion was found in the high grade glioma. The patient's perfusion was different from that of 4 patients. The tumor's classification was consistent with the result of perfusion after operation. It proved that the degree of enhancement did not really represent the classification of the tumor.
Conclusion: the 1.ASL and DSC methods have consistent perfusion results. Because of the noninvasive and convenient ASL, the diagnosis of ASL in the tumor classification is worth promoting.2. in the ASL and DSC methods. The maximum blood flow of high grade glioma is greater than that of low grade glioma. ASL and DSC can be used for the diagnosis of.3. peritematous edema in glioma classification. The value of blood flow can reflect the degree of tumor invasion, which can provide an important auxiliary effect for surgical operation..4.ASL delayed the difference of arrival time of the artery without statistical significance, so it is not significant to change the arrival time of the ASL artery to the tumor classification.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41;R445.2
【參考文獻】
相關(guān)期刊論文 前10條
1 吳少雄,鄧美玲,李巧巧,趙充,盧泰祥,李鳳巖,崔念基;腦膠質(zhì)瘤放射治療的預(yù)后因素分析[J];癌癥;2004年S1期
2 武洪林,陳君坤,張宗軍,黃偉,盧光明,唐曉俊,李林;磁共振灌注成像在腦膠質(zhì)瘤中的應(yīng)用與評價[J];醫(yī)學(xué)研究生學(xué)報;2004年04期
3 楊冬;王忠誠;邱曉光;江濤;張亞卓;;放、化療同步治療高級別膠質(zhì)瘤[J];中華神經(jīng)外科疾病研究雜志;2007年05期
4 蒲俊智,志彥,格根托婭,關(guān)利君,梅曉芳,劉軍;腦膠質(zhì)瘤的CT診斷、分型與病理對照研究(附70例報告)[J];實用放射學(xué)雜志;2002年09期
5 沈海林,葉明,俞志英,黃瑾瑜,周幽心,周岱,丁乙;星形膠質(zhì)細胞瘤微血管成分改變與瘤周水腫MRI相關(guān)因素分析[J];中國醫(yī)學(xué)計算機成像雜志;2001年03期
6 姜濤;張競文;伍建林;宋清偉;;磁共振氫質(zhì)子波譜對腦腫瘤瘤周水腫的臨床應(yīng)用研究[J];中國醫(yī)學(xué)計算機成像雜志;2006年01期
7 馬曉東,周定標,童新元,張紀,段國升,程東源,許百男;幕上低級別星形細胞瘤生存分析[J];中華神經(jīng)外科雜志;1997年02期
8 張懋植;;成人低級別膠質(zhì)瘤的治療進展[J];中國微侵襲神經(jīng)外科雜志;2006年01期
9 屈洪濤,劉運生,肖亞飛,梁有明;膠質(zhì)母細胞瘤PTEN基因突變和ki-67表達的研究[J];中國現(xiàn)代醫(yī)學(xué)雜志;2003年08期
10 姜新雅;王小宜;;磁共振灌注成像及其在腦膠質(zhì)瘤中的臨床應(yīng)用[J];中國現(xiàn)代醫(yī)學(xué)雜志;2006年03期
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