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目的探讨动脉质子自旋标记(ASL)与动态磁敏感对比增强(DSC)灌注技术用于脑胶质瘤分级的可行性。方法经病理证实的28例脑胶质瘤患者,按世界卫生组织2000年规定的胶质瘤分级标准分为高级15例,低级13例。使用3.0 T MR 扫描仪进行 Q2TIPS 的 ASL 检查和静脉团注钆喷替酸葡甲胺(Gd-DTPA)的 DSC 灌注检查。所得数据经两独立样本秩和检验分析,P<0.05为差异有统计学意义;并用直线回归的方法分析两种灌注方法的相关性。结果 ASL 法测得的脑胶质瘤血流量(TBF)/对侧脑白质相对血流量(CBF):高、低级别胶质瘤分别为(5.5±1.8)、(2.1±1.4),DSC 法测得的值分别为(4.3±1.0)、(2.0±1.1),差异均有统计学意义(Z 值分别为-3.824、-3.939,P<0.01);ASL 法测得的 TBF/对侧半球 CBF 值,高、低级别胶质瘤分别为(2.2±0.8)、(0.8±0.5),DSC 法测得的值分别为(2.1±0.8)、(1.0±0.6),差异均有统计学意义(Z 值分别为-3.987、-3.386,P<0.01);ASL 法测得的 TBF/对侧灰质 CBF 值,高、低级别胶质瘤分别为(1.7±0.6)、(0.7±0.5),DSC 法测得值分别为(1.6±0.5)、(0.8±0.4),差异均有统计学意义(Z 值分别为-3.894、-3.754,P<0.01)。两种方法测得的上述比值均密切相关(r 分别为0.91、0.93、0.91,P<0.01)。结论 ASL 可用于胶质瘤微血管灌注的评估,有助于区分低级别和高级别脑胶质瘤。
Objective To investigate the feasibility of arterial proton spin labeling (ASL) and dynamic magnetic susceptibility contrast-enhanced (DSC) perfusion in glioma grading. Methods Twenty-eight patients with glioma confirmed by pathology were divided into 15 cases in advanced class and 13 cases in lower class according to the glioma grading standard stipulated by World Health Organization in 2000. A 3.0 T MR scanner was used for the ASL examination of Q2TIPS and the DSC perfusion test for intravenous bolus injection of Gd-DTPA. The data obtained by two independent sample rank sum test analysis, P <0.05 for the difference was statistically significant; and linear regression analysis of the correlation between the two perfusion methods. Results The gliomas blood flow (TBF) / contralateral white matter relative blood flow (CBF) measured by ASL method were (5.5 ± 1.8) and (2.1 ± 1.4) The measured values were (4.3 ± 1.0) and (2.0 ± 1.1), respectively, and the differences were statistically significant (Z values were -3.824 and -3.939, respectively, P <0.01) The CBF, high and low grade gliomas were (2.2 ± 0.8) and (0.8 ± 0.5), respectively. The values measured by DSC were (2.1 ± 0.8) and (1.0 ± 0.6), respectively, with significant differences (Z values were -3.987 and -3.386, respectively, P <0.01). The levels of TBF / contralateral gray CBF measured by ASL were (1.7 ± 0.6) and (0.7 ± 0.5) The values measured by DSC were (1.6 ± 0.5) and (0.8 ± 0.4) respectively, with statistical significance (Z values were -3.894 and -3.754, respectively, P <0.01). The above ratios measured by the two methods are closely related (r = 0.91,0.93,0.91, P <0.01). Conclusions ASL can be used for the evaluation of glioma microvascular perfusion and help to distinguish between low-grade and high-grade gliomas.