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目的初步探讨利用MRI扩散加权成像(DWI)和弥散张量成像(DTI)评估胶质母细胞瘤(GBM)术后替莫唑胺(TMZ)标准放化疗后早期进展的临床价值。方法观察我院收治GBM术后残留并行TMZ标准放化疗的患者在TMZ同步放化疗前后DWI和DTI的影像学表现,测量残留肿瘤ADC平均值、ADC最小值、FA平均值和FA最小值,计算放疗前后ADC值和FA值的变化率,记录肿瘤早期进展病例,初步评价各项参数预测GBM患者早期进展的临床价值。结果 2013年12月至2014年7月之间,42例患者入组,早期进展12例。所有病例在TMZ同步放化疗结束时ADC值均有升高,在早期进展组中差异无统计学意义,在无早期进展组中差异有统计学意义。ADC最小值在放化疗前后的变化率在两组间差异有统计学意义。放疗结束时的FA值比放疗前轻度升高,但差异无统计学意义,FA值变化率在两组间差异无统计学意义。结论 TMZ同步放化疗前后的ADC值和ADC最小值变化率有助于判断GBM术后残留肿瘤接受TMZ标准放化疗后的早期进展,值得进一步研究。
Objective To investigate the clinical value of using MRI diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) to evaluate the early progress of standard radiotherapy and chemotherapy after temozolomide (TMZ) in patients with glioblastoma (GBM). Methods The imaging findings of DWI and DTI before and after TMZ chemoradiotherapy and chemotherapy were observed in patients with TMZ standard radiotherapy and chemotherapy after TMT standard radiotherapy and chemotherapy in our hospital. The ADC average, ADC minimum, FA average and FA minimum of residual tumor were measured and calculated The changes of ADC value and FA value before and after radiotherapy, recording the early progress of the tumor, and preliminarily evaluating the clinical value of each parameter in predicting the early progress of GBM. Results Between December 2013 and July 2014, 42 patients were enrolled and 12 cases were advanced early. In all cases, the ADC value increased at the end of TMZ concurrent chemoradiotherapy, and there was no significant difference in the early progress group and no significant difference in the early progression group. The change rate of ADC minimum before and after radiotherapy and chemotherapy was statistically significant between the two groups. The FA value at the end of radiotherapy was slightly higher than that before radiotherapy, but the difference was not statistically significant. There was no significant difference in the change rate of FA between the two groups. Conclusions The ADC value and the minimum change rate of ADC before and after TMZ chemoradiotherapy are helpful to judge the early progress of TMZ standard radiotherapy and chemotherapy after residual tumor of GBM, which deserves further study.