From the Departments of Neurosurgery (Q.Z., C.L., J.Z.).
Radiology (B.J., F.D.).
AJNR Am J Neuroradiol. 2017 Oct;38(10):1876-1883. doi: 10.3174/ajnr.A5299. Epub 2017 Jul 20.
Previous studies showed conflicting results concerning the value of CBF maps obtained from arterial spin-labeling MR imaging in grading gliomas. This study was performed to investigate the effectiveness of CBF maps derived from 3D pseudocontinuous arterial spin-labeling in preoperatively assessing the grade, cellular proliferation, and prognosis of gliomas.
Fifty-eight patients with pathologically confirmed gliomas underwent preoperative 3D pseudocontinuous arterial spin-labeling. The receiver operating characteristic curves for parameters to distinguish high-grade gliomas from low-grade gliomas were generated. Pearson correlation analysis was used to assess the correlation among parameters. Survival analysis was conducted with Cox regression.
Both maximum CBF and maximum relative CBF were significantly higher in high-grade gliomas than in low-grade gliomas ( < .001). The areas under the curve for maximum CBF and maximum relative CBF in distinguishing high-grade gliomas from low-grade gliomas were 0.828 and 0.863, respectively. Both maximum CBF and maximum relative CBF had no correlation with the Ki-67 index in all subjects and had a moderate negative correlation with the Ki-67 index in glioblastomas ( = -0.475, -0.534, respectively). After adjustment for age, a higher maximum CBF ( = .008) and higher maximum relative CBF ( = .005) were associated with worse progression-free survival in gliomas, while a higher maximum relative CBF ( = .033) was associated with better overall survival in glioblastomas.
3D pseudocontinuous arterial spin-labeling-derived CBF maps are effective in preoperative evaluation of gliomas. Although gliomas with a higher blood flow are more malignant, glioblastomas with a lower blood flow are likely to be more aggressive.
先前的研究表明，动脉自旋标记磁共振成像获得的 CBF 图在胶质瘤分级中的价值存在矛盾。本研究旨在探讨 3D 伪连续动脉自旋标记衍生的 CBF 图在术前评估胶质瘤分级、细胞增殖和预后方面的有效性。
58 例经病理证实的胶质瘤患者行术前 3D 伪连续动脉自旋标记。生成参数的受试者工作特征曲线，以区分高级别胶质瘤和低级别胶质瘤。采用 Pearson 相关分析评估参数之间的相关性。采用 Cox 回归进行生存分析。
高级别胶质瘤的最大 CBF 和最大相对 CBF 均显著高于低级别胶质瘤（<0.001）。最大 CBF 和最大相对 CBF 区分高级别胶质瘤和低级别胶质瘤的曲线下面积分别为 0.828 和 0.863。最大 CBF 和最大相对 CBF 在所有受试者中与 Ki-67 指数均无相关性，在胶质母细胞瘤中与 Ki-67 指数呈中度负相关（= -0.475，-0.534）。调整年龄后，较高的最大 CBF（=0.008）和较高的最大相对 CBF（=0.005）与胶质瘤无进展生存较差相关，而较高的最大相对 CBF（=0.033）与胶质母细胞瘤总生存较好相关。
3D 伪连续动脉自旋标记衍生的 CBF 图在术前评估胶质瘤方面是有效的。尽管血流较高的胶质瘤恶性程度较高，但血流较低的胶质母细胞瘤可能更具侵袭性。
