摘要
目的 探索高级别胶质瘤的侵袭特点,并应用磁共振弥散张量成像（DTI）定量分析高级别胶质瘤的侵袭范围.方法 回顾性纳入首都医科大学附属北京天坛医院神经外科2014年10月至2016年10月收治的10例额叶高级别胶质瘤（WHOⅢ～Ⅳ）患者.所有患者术前均行头颅MRI及DTI检查,于MRI T1加权增强扫描图像上,分别在肿瘤强化实体、距离强化实体边缘1 cm和2 cm的部位各选取1个感兴趣区;之后应用DTI技术测定3个感兴趣区的各向异性分数（FA）值和表观弥散系数（ADC）值.所有患者均行肿瘤切除术,术后对3个感兴趣区的标本依次进行相关病理学检查和肿瘤细胞比例测定.通过建立判别分析模型,对3个感兴趣区的ADC、FA值与肿瘤细胞比例进行相关性分析.结果 病理学相关结果显示,随着距离肿瘤实体边缘距离的增加,残余肿瘤细胞比例显著减少（均P＜0.05）;基质金属蛋白酶9和Ki-67的表达较肿瘤实体显著下降（均P＜0.05）.通过对3个感兴趣区的ADC、FA值与肿瘤细胞比例进行相关性分析,得到标准化典则判别函数为D=0.201ADC＋1.094FA（其中D为肿瘤细胞的比例,为标准化的数值）,该函数可通过DTI测定的ADC值和FA值预测肿瘤细胞的比例,准确率为66.7％.结论 随着距离高级别胶质瘤实体边缘距离的增加,肿瘤细胞的比例、侵袭性和增殖力均较肿瘤实体明显下降.通过建立判别分析模型,初步得出DTI参数与肿瘤细胞比例的量化关系,以期协助指导临床手术方案的制定.
Objective To explore the invasion characteristics of high-grade gliomas and to quantitatively investigate their infiltration zone using diffusion tensor imaging （DTI）.Methods Ten patients of frontal high-grade gliomas （WHO Ⅲ-Ⅳ） were retrospectively reviewed who were admitted to Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University,China National Clinical Research Center for Neurological Diseases from October 2014 to October 2016.All patients underwent the examination of preoperative MRI and DTI.Three regions of interest （ROI）,which were placed at the enhanced central region of the tumor,1cm and 2cm from the tumor edge,were determined on T1-weighted imaging with contrast medium.Apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of those ROIs were measured prior to surgery.Before the incision of dura matter,specimens of those ROIs were obtained under the guidance of navigation.Postoperative examinations of specimens including histological,tumor cell density,MMP-9 and Ki-67 were carried out.Differences in tumor cell density,MMP-9 and Ki-67 values among 3 ROIs were analyzed.Correlations among the ADC,FA values and the tumor cell density were also evaluated.Results As the distance from the tumor entity increased,tumor cell density,expression levels of MMP-9 and Ki-67 significantly decreased compared with those in tumor entity （all P 〈 0.05）.To analyze the relationship of tumor cell density to ADC and FA values,the canonical discriminant formula was as follows：D =0.201 ADC ＋ 1.094 FA,which could be used to determine the tumor cell density with an accuracy rate of 66.7%.Conclusions As the distance from tumor entity increased,tumor cell density,invasion and proliferation decrease significantly compared with the tumor entity.There seems to be a quantitative relationship between DTI parameters and tumor cell density of high-grade gliomas,which could contribute to the formulation of surgical plan.
作者
侯宗刚
蔡旭
谢坚
李欢
曾春
王江飞
高之宪
张明宇
张柠
Hou Zonggang;Cai Xu;Xie Jian;Li Huan;Zeng Chun;Wang Jiangfei;Gao Zhixian;Zhang Mingyu;Zhang Ning(Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing 100050, China)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第4期344-348,共5页
Chinese Journal of Neurosurgery
基金
国家“十二五”科技支撑计划（2014BAI04B01）
北京市科委首都市民健康项目培育（Z131100006813011）
关键词
神经胶质瘤
肿瘤侵润
弥散张量成像
Glioma
Neoplasm invasiveness
Diffusion tensor imaging
