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目的初步探讨MRI弥散加权成像(DWI)和弥散张量成像(DTI)在高级别胶质瘤(HGG)术后放疗靶区勾画中的应用价值。方法对复旦大学附属华山医院上海伽玛医院收治的HGG术后残留患者做前瞻性研究。所有患者放疗前行DWI和DTI检查,在ADC图和FA图上分别测量残留肿瘤、肿瘤外1 cm区域内(定义为近瘤周区)、1~2 cm区域内(定义为中瘤周区)、2~3 cm区域内(定义为远瘤周区)及3~4 cm区域内(定义为瘤周区外)和对侧正常脑组织的ADC平均值、ADC最小值、FA平均值和FA最小值。结果 2013年9月至2014年8月,共有55例HGG患者入组,ADC平均值和最小值呈现从残留肿瘤、近瘤周区到中瘤周区逐渐升高的趋势,并从中瘤周区、远瘤周区到瘤周区外逐渐降低;其中,残留肿瘤与近瘤周区,以及中瘤周区与远瘤周区、远瘤周区与瘤周区外比较,差异均有统计学意义(均P<0.05);FA平均值和最小值呈现从残留肿瘤、近瘤周区、中瘤周区、远瘤周区到瘤周区外逐渐升高的趋势,但各区差别无统计学意义(均P>0.05)。结论本研究初步显示DWI技术可能有助于术后HGG及肿瘤周边组织性质的确定,指导HGG术后放疗靶区的勾画;FA值对于靶区勾画的价值有待进一步研究。
Objective To investigate the value of MRI diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) in delineating radiotherapy target areas after high-grade gliomas (HGG). Methods A prospective study was conducted on residual HGG patients admitted to Shanghai Gama Hospital affiliated to Huashan Hospital of Fudan University. All patients underwent DWI and DTI before radiotherapy. Residual tumors were measured on the ADC and FA maps. The area within 1 cm of the tumor (defined as the peritumoral neoplasia region) and the 1-2 cm region (defined as the peritumoral neoplasia region ), ADC in the range of 2 ~ 3 cm (defined as the peritumoral area) and in the 3 ~ 4 cm area (defined as the peritumoral area) and contralateral normal brain tissue FA minimum. Results From September 2013 to August 2014, a total of 55 HGG patients were enrolled. The mean and minimum ADC values showed a gradual increase from the residual tumor, proximal tumor area to mid-tumor area, and from mid-tumor area , The peritumoral area gradually decreased to the periphery of the peritumoral region. Among them, the difference between the residual tumor and the neoplastic region, the neoplastic region and the neoplastic region, the neoplastic region and the neoplastic region were statistically significant (All P <0.05). The mean and minimum values of FA showed a tendency of increasing from residual tumor, peritumoral neoplasia, middle neoplasm, perinatal neoplasm to peritumorous neoplasm, but there was no statistical difference Significance (all P> 0.05). Conclusions This study shows that DWI may be helpful for the determination of the postoperative HGG and the surrounding tissue, guiding the outline of postoperative radiotherapy target of HGG. The value of FA for the delineation of the target remains to be further studied.