Cao Mengqiu, Suo Shiteng, Han Xu, Jin Ke, Sun Yawen, Wang Yao, Ding Weina, Qu Jianxun, Zhang Xiaohua, Zhou Yan
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Aging Neurosci. 2018 Jan 8;9:432. doi: 10.3389/fnagi.2017.00432. eCollection 2017.
: To evaluate the feasibility of a simplified method based on diffusion-weighted imaging (DWI) acquired with three -values to measure tissue perfusion linked to microcirculation, to validate it against from perfusion-related parameters derived from intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging, and to investigate its utility to differentiate low- from high-grade gliomas. : The prospective study was approved by the local institutional review board and written informed consent was obtained from all patients. From May 2016 and May 2017, 50 patients confirmed with glioma were assessed with multi--value DWI and DCE MR imaging at 3.0 T. Besides conventional apparent diffusion coefficient (ADC) map, perfusion-related parametric maps for IVIM-derived perfusion fraction () and pseudodiffusion coefficient (D*), DCE MR imaging-derived pharmacokinetic metrics, including K, v and v, as well as a metric named simplified perfusion fraction (SPF), were generated. Correlation between perfusion-related parameters was analyzed by using the Spearman rank correlation. All imaging parameters were compared between the low-grade ( = 19) and high-grade ( = 31) groups by using the Mann-Whitney test. The diagnostic performance for tumor grading was evaluated with receiver operating characteristic (ROC) analysis. : SPF showed strong correlation with IVIM-derived and D* ( = 0.732 and 0.716, respectively; both < 0.001). Compared with , SPF was more correlated with DCE MR imaging-derived K ( = 0.607; < 0.001) and v ( = 0.397; = 0.004). Among all parameters, SPF achieved the highest accuracy for differentiating low- from high-grade gliomas, with an area under the ROC curve value of 0.942, which was significantly higher than that of ADC ( = 0.004). By using SPF as a discriminative index, the diagnostic sensitivity and specificity were 87.1% and 94.7%, respectively, at the optimal cut-off value of 19.26%. : The simplified method to measure tissue perfusion based on DWI by using three -values may be helpful to differentiate low- from high-grade gliomas. SPF may serve as a valuable alternative to measure tumor perfusion in gliomas in a noninvasive, convenient and efficient way.
为评估基于采用三个值获取的扩散加权成像（DWI）来测量与微循环相关的组织灌注的简化方法的可行性，将其与体素内不相干运动（IVIM）和动态对比增强（DCE）磁共振（MR）成像得出的灌注相关参数进行验证，并研究其在鉴别低级别与高级别胶质瘤方面的效用。前瞻性研究经当地机构审查委员会批准，并获得所有患者的书面知情同意。2016年5月至2017年5月，对50例确诊为胶质瘤的患者在3.0 T条件下进行多值DWI和DCE MR成像评估。除了传统的表观扩散系数（ADC）图外，还生成了IVIM衍生的灌注分数（）和伪扩散系数（D*）、DCE MR成像衍生的药代动力学指标（包括K、v和v）以及一个名为简化灌注分数（SPF）的指标的灌注相关参数图。采用Spearman秩相关分析灌注相关参数之间的相关性。使用Mann-Whitney检验比较低级别（=19）和高级别（=31）组之间的所有成像参数。采用受试者操作特征（ROC）分析评估肿瘤分级的诊断性能。SPF与IVIM衍生的和D*显示出强相关性（分别为=0.732和0.716；均<0.001）。与相比，SPF与DCE MR成像衍生的K（=0.607；<0.001）和v（=0.397；=0.004）的相关性更强。在所有参数中，SPF在鉴别低级别与高级别胶质瘤方面具有最高的准确性，ROC曲线下面积值为0.942，显著高于ADC（=0.004）。以SPF作为判别指标，在最佳截断值为19.26%时，诊断敏感性和特异性分别为87.1%和94.7%。基于DWI采用三个值测量组织灌注的简化方法可能有助于鉴别低级别与高级别胶质瘤。SPF可以作为一种有价值的替代方法，以无创、方便和高效的方式测量胶质瘤中的肿瘤灌注。
