摘要
目的研究应用MR三维动脉自旋标记(3D-ASL)成像在预测肺癌脑转移瘤(BMs)病理类型中的诊断价值。方法回顾性分析237例经病理证实为原发性肺癌BMs患者,均行头颅3.0 T MR扫描成像,扫描序列包括增强T_(1)WI、T_(2)-FLAIR、ASL灌注图像,分别在BMs实性区、瘤周水肿区、对侧镜像区及正常脑白质区勾画感兴趣区域(ROIs)测量平均最大脑血流量(CBF),计算BMs实性区、瘤周水肿区相对脑血流量(rCBF)和灌注差值比(△CBF),并比较不同病理类型肺癌BMs在各定量参数的差异性及预测肺癌BMs病理类型的效能。结果BMs腺癌组rCBF_(实性区)平均值为1.70±0.61,较鳞癌组(1.44±0.44)及小细胞肺癌组(1.08±0.30)分别升高18.1%、57.4%(P<0.05);△CBF_(实性区)平均值为1.10±0.67,较鳞癌组(0.84±0.53)及小细胞肺癌组(0.43±0.48)分别升高30.9%、155.8%(P<0.05)。BMs鳞癌组rCBF_(水肿区)平均值为0.51±0.13,较腺癌组(0.58±0.15)及小细胞肺癌组(0.59±0.21)分别降低12.1%、13.6%(P<0.05);CBF_(水肿区)平均值为17.68±3.45,较腺癌组(20.88±5.88)及小细胞肺癌组(23.17±5.61)分别降低15.3%、23.7%(P<0.05)。在鉴别小细胞肺癌与鳞癌、腺癌BMs诊断中,rCBF_(实性区)的AUC值最高,为0.828(0.774~0.883),最佳阈值为1.185,敏感度为72.1%,特异度为82.3%。结论3D-ASL可客观反映不同病理型肺癌BMs在肿瘤靶区、瘤周水肿区脑血流灌注情况。rCBF_(实性区)、CBF_(水肿区)、△CBF_(实性区)参数有助于预测肺癌BMs病理分型。
Objective This study aimed to evaluate the diagnostic performance of three-dimensional arterial spin labeling(3D-ASL)imaging in predicting pathological types of lung cancer brain metastases(BMs).Methods A total of 237 patients with pathology confirmed primary lung cancer with BMs were retrospectively analyzed.3.0 T MR images of BMs patients were collected(including enhanced T_1WI,T_2-FLAIR,and ASL perfusion images).Regions of interest(ROIs)were manually drawn on solid of BMs,peritumoral edema,contralateral normal-appearing white matter(CNAWM)and mirror brain tissue to measure the mean maximum of CBF.relative cerebral blood flow(rCBF)and difference ratio of change(△CBF)were calculated to compare the differences in all quantitative parameters of different pathological types of lung cancer BMs and the performance of predicting the pathological type of BMs from lung cancer.Results In AC brain metastases group,The mean value of rCBF_(intra)was 1.70±0.61,which was increased by 18.1%and 57.4%compared with SCC group(1.44±0.44),and SCLC group(1.08±0.30)(P<0.05).The mean value of△CBF_(intra)was 1.10±0.67,which was 30.9%and 155.8%higher than those in SCC group(0.84±0.53)and SCLC group(0.43±0.48)(P<0.05).In SCC brain metastases group,the mean value of rCBF_(per)was 0.51±0.13,which was decreased by 12.1%and 13.6%compared with AC group(0.58±0.15)and SCLC group(0.59±0.21)(P<0.05).The average CBF_(per)was 17.68±3.45,which was 15.3%and 23.7%lower than those in AC group(20.88±5.88),and SCLC group(23.17±5.61).Differentiation of BMs from SCLC and NSCLC showed that rCBF_(intra)of AUC was 0.828 with 72.1%sensitivity and 82.3%specificity,at the cut-off value of 1.185.Conclusion 3D-ASL can objectively reflect the cerebral blood perfusion in BMs of the tumor target and peritumoral edema areas from different pathological types of lung cancer BMs.rCBF_(intra),△CBF_(intra)and CBF_(per)can help distinguish among SCC,AC and SCLC,to guide the diagnosis and treatment for BMs patients.
作者
杨厚义
巩贯忠
徐菁
钟慧
苏亚
王俪臻
尹勇
YANG Houyi;GONG Guanzhong;XU Jing(Graduate Faculty,Shandong First Medical University(Shandong Academy of Medical Sciences)Jinan,Shandong Province 250000,P.R.China)
出处
《临床放射学杂志》
北大核心
2023年第7期1066-1071,共6页
Journal of Clinical Radiology
基金
山东省肿瘤医院临床研究培育项目资助(编号:YYPY2020-016)。
