IVIM、ASL及DWI對高級別膠質(zhì)瘤1年無進展生存期的預測價值
發(fā)布時間：2018-09-14 12:06
【摘要】：目的:本研究旨在探討高級別膠質(zhì)瘤患者的MRI多功能成像(3D-PCASL、常規(guī)DWI及IVIM-DWI技術(shù))和臨床特征,探討其對高級別膠質(zhì)瘤1年無進展生存期的預測價值,找出獨立預后因素。材料與方法:1.收集高級別膠質(zhì)瘤患者31例(男性15例,女性16例),年齡范圍:12-73歲,平均年齡53.1歲,包括WHO III級14例,WHO IV級17例。2.所有患者均在3.0T磁共振完成常規(guī)顱腦平掃序列(橫斷位T1WI、T2WI、DWI、矢狀位T1WI、冠狀位T2FLAIR);多b值擴散加權(quán)成像序列(IVIM-DWI)和三維偽連續(xù)式動脈自旋標記序列(3D-PCASL);增強掃描(橫斷位、矢狀位及冠狀位T1WI)。3.通過AW4.6工作站Function tool軟件,IVIM-DWI經(jīng)后處理獲得慢擴散系數(shù)D(slow ADC)、快擴散系數(shù)D*(fast ADC)及快擴散所占的容積分數(shù)f(fraction of fast ADC)三種參數(shù)化圖像;常規(guī)DWI經(jīng)后處理獲得擴散系數(shù)(ADC)圖像;ASL經(jīng)后處理獲得腦血流量(CBF)圖像。4.結(jié)合多方位T1WI增強掃描圖像,在IVIM后處理中選取腫瘤D圖最低區(qū)域手動繪制感興趣區(qū),得到參數(shù)D值、D*值和f值。在ASL后處理中選取高灌注區(qū)繪制感興趣區(qū),得到CBF值,同時對側(cè)正常腦實質(zhì)放置相應感興趣區(qū),計算出rCBF值(rCBF值=病灶CBF值/鏡像側(cè)CBF值)。在DWI后處理中選取ADC圖最低區(qū)域手動繪制感興趣區(qū),得到參數(shù)ADC值。均繪制3個感興趣區(qū),盡量避開腫瘤囊變、壞死區(qū)域及血管走形區(qū)域,取均值,ROI面積約50mm2。5.所有患者均行手術(shù)完全切除或部分切除腫瘤,并術(shù)后進行替莫唑胺的輔助化療和同步放療。所有患者術(shù)后每3個月做一次MRI檢查隨訪。本研究的起點是腫瘤手術(shù)時間,研究終點是腫瘤影像學進展時間或死亡日期,或最后一次隨訪觀察日期(即2017年3月1日)。統(tǒng)計出患者的無進展生存時間。6.統(tǒng)計學分析:(1)所有患者的腫瘤平均rCBF、ADC、D、D*及f值均進行ROC曲線分析,得到其閾值、敏感度及特異度,并與病理學分級進行比較。(2)采用Kaplan-Meier方法統(tǒng)計患者生存率,并采用Log rank法對患者生存情況進行檢驗。(3)采用Cox比例風險回歸模型對所有影像學參數(shù)和臨床特征分別進行單因素和多因素分析。所有統(tǒng)計分析均以P0.05表示差異有統(tǒng)計學意義。結(jié)果:1.臨床特征:(1)高級別膠質(zhì)瘤患者(共31例):男性/女性:15/16例;年齡12-73歲,平均年齡53.1歲;手術(shù)完全/部分切除腫瘤:20/11例;PFS為63-732天;1年內(nèi)無進展/進展人數(shù):16/15例。(2)III級(共14例):男性/女性:6/8例;年齡30-67歲;手術(shù)完全/部分切除腫瘤:10/4例;PFS為90-473天;1年內(nèi)無進展/進展人數(shù):8/6例。(3)IV級(共17例):男性/女性:9/8例;年齡12-73歲;手術(shù)完全/部分切除腫瘤:10/7例;PFS為63-732天;1年內(nèi)無進展/進展人數(shù):8/9例。2.ROC曲線分析(各參數(shù)值對于高級別膠質(zhì)瘤1年P(guān)FS預測價值):(1)IVIM:(1)D*值的Az=0.602,閾值為3.28,敏感度和特異度分別為86.7%和50.0%。(2)D值的Az=0.725,閾值為0.522,敏感度和特異度分別為66.7%和87.5%。(3)f值的Az=0.708,閾值為0.408,敏感度和特異度分別為86.7%和62.5%。(2)ASL:rCBF值的Az=0.825,閾值為6.408,敏感度和特異度分別為66.7%和87.5%。(3)DWI:ADC值的Az=0.771,閾值為0.741,敏感度和特異度分別為80.0%和81.2%。3.Kaplan-Meier曲線分析(各參數(shù)值預測生存期的價值有無統(tǒng)計學差異):(1)IVIM:(1)D*3.28×10-3mm2/s時,PFS無統(tǒng)計學差異(P=0.067)。(2)D≤0.522×10-3mm2/s時,PFS明顯下降,有統(tǒng)計學差異(P=0.00004)。(3)f≤0.408時,PFS明顯下降,有統(tǒng)計學差異(P=0.007)。(2)ASL:rCBF6.408時,PFS明顯下降,有統(tǒng)計學差異(P=0.003)。(3)DWI:ADC≤0.741×10-3mm2/s時,PFS明顯下降,有統(tǒng)計學差異(P=0.00005)。4.Cox回歸模型單因素分析(高級別膠質(zhì)瘤1年P(guān)FS的影響因素):(1)臨床特征:(1)性別、年齡的P值分別為0.086、0.072,HR分別為2.570、1.046,95%CI分別為0.876-7.542、0.996-1.099。(2)完全切除腫瘤、病理分級的P值分別為0.0002、0.420,HR分別為8.167、1.532,95%CI分別為2.688-24.80、0.544-4.313。(2)IVIM:(1)D值、D*值的P值分別為0.0003、0.088,HR分別為0.134、3.676,95%CI分別為0.044-0.404、0.826-16.36。(2)f值的P值為0.018,HR為0.164,95%CI為0.037-0.731。(3)ASL:rCBF值的P值為0.006,HR為4.587,95%CI為1.552-13.563。(4)DWI:ADC值的P值為0.001,HR為0.107,95%CI為0.029-0.388。5.Cox回歸模型多因素分析(高級別膠質(zhì)瘤1年P(guān)FS的獨立預后因素):(1)臨床特征:完全切除腫瘤的P值為0.023,HR為4.582,95%CI為1.233-17.025。(2)IVIM:(1)D值的P值為0.620,HR為0.617,95%CI為0.091-4.166。(2)f值的P值為0.006,HR為0.080,95%CI為0.013-0.490。(3)ASL:rCBF值的P值為0.029,HR為5.162,95%CI為1.180-22.577。(4)DWI:ADC值的P值為0.081,HR為0.132,95%CI為0.014-1.285。結(jié)論:ASL成像中的rCBF值和IVIM成像中的f值均是預測高級別膠質(zhì)瘤1年P(guān)FS較好的獨立預后因素,其中rCBF值的預測效能最高(AUC=0.825,閾值為6.408),IVIM-f值的預測效能中等(AUC=0.708),其它的影像學參數(shù)均不是預測PFS的獨立預后因素。而IVIM掃描時間過長,為ASL的1.5倍,圖像后處理較繁瑣。DWI作為常規(guī)成像,從信號強度判斷良惡性有一定價值,ADC值的預測效能不如rCBF值。因此,三種MRI功能成像中,ASL的rCBF值對于高級別膠質(zhì)瘤1年無進展生存期的預測價值是最好的。
[Abstract]:Objective: To investigate the MRI multifunctional imaging (3D-PCASL, conventional DWI and IVIM-DWI) and clinical features in patients with high-grade gliomas, and to explore its predictive value for 1-year progression-free survival of high-grade gliomas, and to identify independent prognostic factors. Materials and methods: 1. 31 patients with high-grade gliomas (15 males and 16 females) were collected. Age range: 12-73 years, mean age 53.1 years, including WHO III grade 14 cases, WHO IV grade 17 cases.2. All patients were performed routine brain plain scan sequence (transverse T1WI, T2WI, DWI, sagittal T1WI, coronal T2FLAIR); Multi-b value diffusion weighted imaging sequence (IVIM-DWI) and three-dimensional pseudo-continuous arterial spin labeling sequence (3D-PCASL); Strong scan (transverse, sagittal and coronal T1WI). 3. Through AW4.6 workstation Function tool software, IVIM-DWI after post-processing to obtain slow diffusion coefficient D (slow ADC), fast diffusion coefficient D * (fast ADC) and fast diffusion volume fraction of fast ADC (fraction of fast ADC) three parametric images; conventional DWI after post-processing to obtain diffusion coefficient (ADC) images; Cerebral blood flow (CBF) images were obtained by SL post-processing. 4. Combined with multi-directional T1WI enhanced images, the lowest region of tumor D was selected to draw the region of interest manually in IVIM post-processing, and the parameters D, D * and F were obtained. After DWI, the lowest region of ADC was selected to draw the region of interest manually, and the parameters of ADC were obtained. All three regions of interest were drawn to avoid cystic degeneration, necrotic area and vascular transverse area. The mean ROI area was about 50mm2.5. All patients underwent complete resection. All patients received adjuvant chemotherapy and concurrent radiotherapy with temozolomide every three months. The starting point of this study was the time of tumor surgery. The end point of the study was the time of tumor imaging progression or death, or the last follow-up observation date (March 1, 2017). Statistical analysis: (1) ROC curves were used to analyze the tumor mean values of rCBF, ADC, D, D * and f, and the thresholds, sensitivity and specificity were obtained, and compared with pathological grades. (2) Kaplan-Meier method was used to calculate the survival rate of patients, and Log rank method was used to test the survival of patients. (3) The Cox proportional hazard regression model was used to analyze all imaging parameters and clinical features. All statistical analyses were statistically significant with P 0.05. Results: 1. Clinical features: (1) High-grade glioma patients (31 cases): male / female: 15/16 cases; age 12-73 years old, average age 53.1 years old; operation finished; Total/partial tumor resection: 20/11 cases; PFS: 63-732 days; no progress / progression in 1 year: 16/15 cases. (2) Grade III (14 cases): male/female: 6/8 cases; age 30-67 years; total/partial tumor resection: 10/4 cases; PFS: 90-473 days; no progress / progression in 1 year: 8/6 cases. (3) Grade IV (17 cases): male/female: 9/8 cases; age 12-73 years; surgery; Complete/partial resection of the tumor: 10/7; PFS 63-732 days; no progress/progression within one year: 8/9.2. ROC curve analysis (predictive value of each parameter value for PFS in high-grade gliomas for one year): (1) IVIM: (1) D * Az = 0.602, threshold value 3.28, sensitivity and specificity 86.7% and 50.0% respectively. (2) D Az = 0.725, threshold value 0.522, sensitivity and specificity (3) Az = 0.708, threshold value is 0.408, sensitivity and specificity are 86.7% and 62.5% respectively. (2) Az = 0.825, threshold value is 6.408, sensitivity and specificity are 66.7% and 87.5%. (3) Az = 0.771, sensitivity and specificity are 80.0% and 81.2% respectively. (2) When D < 0.522 *10-3mm2/s, PFS decreased significantly (P = 0.00004). (3) When f < 0.408, PFS decreased significantly (P = 0.007). (2) When ASL: rCBF6.408, PFS decreased significantly (P = 0.007). Statistical difference (P = 0.003). (3) When DWI: ADC < 0.741 *10-3 mm2/s, PFS decreased significantly, with statistical difference (P = 0.00005). 4. Cox regression model univariate analysis (influencing factors of PFS in high grade gliomas for one year): (1) Clinical features: (1) P values of sex, age were 0.086, 0.072, HR were 2.570, 1.046, 95% CI were 0.876-7.542, 0.996-1.099, respectively. (2) For complete resection of tumor, the P values of pathological grade were 0.0002, 0.420, 0.0002, 0.420, HR 8.167, 1.532, 95% CI were 2.688-24.80, 0.544-4.313. (2) IVIM: (1) D value, P value of D * value 0.0003, 0.088, P value 0.088, HR 0.134, 3.676, 95% CI were 0.134, 3.134, 3.676, 95% CI were 0.044-0.044-0.404, 0.40.826-16.36. (2) F value was 0.018, HR 0.018, HR 0.164, HR 0.164, 95% CI 0.164 731. (3) ASL: rC The P value of BF was 0.006, HR was 4.587, 95% CI was 1.552-13.563. (4) The P value of DWI: ADC was 0.001, HR was 0.107, 95% CI was 0.029-0.388.5. Multivariate analysis of Cox regression model (independent prognostic factors of 1-year PFS in high grade gliomas): (1) Clinical features: P value of completely resected tumors was 0.023, HR was 4.582, 95% CI was 1.233-17.025. (2) IVIM:(1) P value (2) P value of F value was 0.006, HR was 0.080, 95% CI was 0.013-0.490. (3) P value of ASL: rCBF value was 0.029, HR was 5.162, 95% CI was 1.180-22.577. (4) P value of DWI: ADC value was 0.081, HR was 0.132, 95% CI was 0.014-1.285. Among the independent prognostic factors, rCBF had the highest predictive power (AUC = 0.825, threshold 6.408), IVIM-f had the moderate predictive power (AUC = 0.708), and other imaging parameters were not independent prognostic factors for PFS. The predictive power of ADC value is inferior to that of rCBF value. Therefore, ASL rCBF value is the best predictive value for 1-year progression-free survival of high-grade gliomas.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R739.41
本文編號：2242662
[Abstract]:Objective: To investigate the MRI multifunctional imaging (3D-PCASL, conventional DWI and IVIM-DWI) and clinical features in patients with high-grade gliomas, and to explore its predictive value for 1-year progression-free survival of high-grade gliomas, and to identify independent prognostic factors. Materials and methods: 1. 31 patients with high-grade gliomas (15 males and 16 females) were collected. Age range: 12-73 years, mean age 53.1 years, including WHO III grade 14 cases, WHO IV grade 17 cases.2. All patients were performed routine brain plain scan sequence (transverse T1WI, T2WI, DWI, sagittal T1WI, coronal T2FLAIR); Multi-b value diffusion weighted imaging sequence (IVIM-DWI) and three-dimensional pseudo-continuous arterial spin labeling sequence (3D-PCASL); Strong scan (transverse, sagittal and coronal T1WI). 3. Through AW4.6 workstation Function tool software, IVIM-DWI after post-processing to obtain slow diffusion coefficient D (slow ADC), fast diffusion coefficient D * (fast ADC) and fast diffusion volume fraction of fast ADC (fraction of fast ADC) three parametric images; conventional DWI after post-processing to obtain diffusion coefficient (ADC) images; Cerebral blood flow (CBF) images were obtained by SL post-processing. 4. Combined with multi-directional T1WI enhanced images, the lowest region of tumor D was selected to draw the region of interest manually in IVIM post-processing, and the parameters D, D * and F were obtained. After DWI, the lowest region of ADC was selected to draw the region of interest manually, and the parameters of ADC were obtained. All three regions of interest were drawn to avoid cystic degeneration, necrotic area and vascular transverse area. The mean ROI area was about 50mm2.5. All patients underwent complete resection. All patients received adjuvant chemotherapy and concurrent radiotherapy with temozolomide every three months. The starting point of this study was the time of tumor surgery. The end point of the study was the time of tumor imaging progression or death, or the last follow-up observation date (March 1, 2017). Statistical analysis: (1) ROC curves were used to analyze the tumor mean values of rCBF, ADC, D, D * and f, and the thresholds, sensitivity and specificity were obtained, and compared with pathological grades. (2) Kaplan-Meier method was used to calculate the survival rate of patients, and Log rank method was used to test the survival of patients. (3) The Cox proportional hazard regression model was used to analyze all imaging parameters and clinical features. All statistical analyses were statistically significant with P 0.05. Results: 1. Clinical features: (1) High-grade glioma patients (31 cases): male / female: 15/16 cases; age 12-73 years old, average age 53.1 years old; operation finished; Total/partial tumor resection: 20/11 cases; PFS: 63-732 days; no progress / progression in 1 year: 16/15 cases. (2) Grade III (14 cases): male/female: 6/8 cases; age 30-67 years; total/partial tumor resection: 10/4 cases; PFS: 90-473 days; no progress / progression in 1 year: 8/6 cases. (3) Grade IV (17 cases): male/female: 9/8 cases; age 12-73 years; surgery; Complete/partial resection of the tumor: 10/7; PFS 63-732 days; no progress/progression within one year: 8/9.2. ROC curve analysis (predictive value of each parameter value for PFS in high-grade gliomas for one year): (1) IVIM: (1) D * Az = 0.602, threshold value 3.28, sensitivity and specificity 86.7% and 50.0% respectively. (2) D Az = 0.725, threshold value 0.522, sensitivity and specificity (3) Az = 0.708, threshold value is 0.408, sensitivity and specificity are 86.7% and 62.5% respectively. (2) Az = 0.825, threshold value is 6.408, sensitivity and specificity are 66.7% and 87.5%. (3) Az = 0.771, sensitivity and specificity are 80.0% and 81.2% respectively. (2) When D < 0.522 *10-3mm2/s, PFS decreased significantly (P = 0.00004). (3) When f < 0.408, PFS decreased significantly (P = 0.007). (2) When ASL: rCBF6.408, PFS decreased significantly (P = 0.007). Statistical difference (P = 0.003). (3) When DWI: ADC < 0.741 *10-3 mm2/s, PFS decreased significantly, with statistical difference (P = 0.00005). 4. Cox regression model univariate analysis (influencing factors of PFS in high grade gliomas for one year): (1) Clinical features: (1) P values of sex, age were 0.086, 0.072, HR were 2.570, 1.046, 95% CI were 0.876-7.542, 0.996-1.099, respectively. (2) For complete resection of tumor, the P values of pathological grade were 0.0002, 0.420, 0.0002, 0.420, HR 8.167, 1.532, 95% CI were 2.688-24.80, 0.544-4.313. (2) IVIM: (1) D value, P value of D * value 0.0003, 0.088, P value 0.088, HR 0.134, 3.676, 95% CI were 0.134, 3.134, 3.676, 95% CI were 0.044-0.044-0.404, 0.40.826-16.36. (2) F value was 0.018, HR 0.018, HR 0.164, HR 0.164, 95% CI 0.164 731. (3) ASL: rC The P value of BF was 0.006, HR was 4.587, 95% CI was 1.552-13.563. (4) The P value of DWI: ADC was 0.001, HR was 0.107, 95% CI was 0.029-0.388.5. Multivariate analysis of Cox regression model (independent prognostic factors of 1-year PFS in high grade gliomas): (1) Clinical features: P value of completely resected tumors was 0.023, HR was 4.582, 95% CI was 1.233-17.025. (2) IVIM:(1) P value (2) P value of F value was 0.006, HR was 0.080, 95% CI was 0.013-0.490. (3) P value of ASL: rCBF value was 0.029, HR was 5.162, 95% CI was 1.180-22.577. (4) P value of DWI: ADC value was 0.081, HR was 0.132, 95% CI was 0.014-1.285. Among the independent prognostic factors, rCBF had the highest predictive power (AUC = 0.825, threshold 6.408), IVIM-f had the moderate predictive power (AUC = 0.708), and other imaging parameters were not independent prognostic factors for PFS. The predictive power of ADC value is inferior to that of rCBF value. Therefore, ASL rCBF value is the best predictive value for 1-year progression-free survival of high-grade gliomas.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R739.41
【參考文獻】
相關(guān)期刊論文 前1條
1 王健;錢銀鋒;楊奇芳;李敏;;多b值DWI鑒別高級別膠質(zhì)瘤及腦轉(zhuǎn)移瘤[J];臨床放射學雜志;2015年10期
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