ct灌注成像在胶质瘤和脑膜瘤术前诊断中的应用研究-影像医学与核医学专业毕业论文.docx

cT灌注成像在胶质瘤及脑膜瘤术前诊断中的应用研究
中文摘要
目的探讨CT血流灌注对胶质瘤术前分级和脑膜瘤术前分型的临床应用价值材料与方法对经手术病理证实的22例胶质瘤及23例脑膜瘤患者患者进行CT 血流灌注成像及常规MR]增强扫描。胶质瘤病例根据病理分级分别将病例分为低级别和高级别两组进行分析,脑膜瘤病例则根据病理分型将其分为纤维型、血管瘤型及上皮型三组。分析肿瘤的MR形态学特征,计算各型脑膜瘤肿瘤实质区的强化率。CT原始图像传送至工作站经灌注软件处理获得时间-密度曲线及灌注伪彩图,在伪彩图像上分别测量肿瘤实质、囊变坏死、瘤周水肿及对侧正常脑白质及脑灰质的灌注参数。。结果低、±, ±,+,±,,组间差异均有统计学意义(P<)。以CBV、PS绘制ROC曲线,显示后者对胶质瘤级别判定的敏感性和特异性较前者高。低、高级别胶质瘤的CBV与Ps间 ,,仅在高级别组内CBV和Ps存在相关性(P<)。少突胶质瘤的CBV与高级别组有明显交叉,但Ps值无明显升高。各型脑膜瘤的CBV、CBF、PS间存在统计学差异,而各型脑膜瘤的MTT无显著性差异。MⅪ增强检查强化率在血管瘤型与纤维型、上皮型脑膜瘤闻有显著性差异。同时,将水肿程度与Ps值进行Spearman秩相关分析,r=(P<)。肿瘤实质区CBV、CBF、PS与相应部位MR上测得的强化率比较,所得Pearson ,,(P<)。结论CT灌注能够提供胶质瘤血管生成的信息,结合CBV与Ps参数能在术前有效地评价胶质瘤的病理级别。脑膜瘤MR强化率与CT灌注值间具有明显的正相关,两者对脑膜瘤的术前分型均有诊断价值,但CT灌注能够提供更详细明确的血液动力学信息,包括对瘤周水肿的灌注状况。
【关键词】体层摄影技术,x线计算机;胶质瘤;脑膜瘤;血流灌注
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Clinical Value of Multislice CT Perfusion Imaging in Preoperative Evaluation of Gliomas and Meningiomas
ENGLISH ABSTRACT
Purpose:To evaluate the preoperative values in diagnosis of subtypes in meningiomas and glioma grade by using nmltislice helical CT perfusion imaging· Materials and Methods:22 patients with gliomas and 23 patients with meningiomas underwent conventional MR and multislice CT perfusion imaging
to the pathologic results,patients with meningiomas w黜
divided into three subtype groups,while patient with gliomas were divided into low grade and high grade groups which were correspond to WHO I or II grade gliomas and WHO III or IV grade gliomas respectively,A contrast enhancement ratio(CER)
was calculated to assess the difference in degree of enhancement in meningiomas
data were transferred to on-line working station and processed to obtain CHIVES,color perfusion maps and calculated perfusion parameters, including cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT)and permeability sur