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目的比较以增强T_1WI(CE-T_1WI)及FLAIR序列为参照时,胶质瘤治疗后高b值DWI成像ADC值测量对在鉴别胶质瘤治疗后进展与非进展判断的差异。方法 47例连续脑胶质瘤术后放化疗患者,治疗前、后行CET_1WI、FLAIR和多b值DWI(b=1000、2000、3000 s/mm~2),分别获取两组ADC图[ADC(3000/1000),ADC(3000/2000)]。47例共59个强化+FLAIR高信号病变;按RANO标准分为进展组(27例30个病灶)与非进展组(20例29个病灶)。测量两组强化与FLAIR高信号对应区域的平均ADC值(CADC_(mean)与FADC_(mean))和最小ADC值(CADC_(min)与FADC_(min)),计算r ADC。运用两独立样本t检验及Wilcoxon秩和检验分别比较两组ADC值的差异,采用ROC曲线分析两种测量方法评价肿瘤进展的效率。结果两组ADC图中进展组平均ADC值及其相对值(两种测量方法)均低于非进展组(P<0.05)。进展组对应于CE-T_1WI和FLAIR高信号区的最小ADC值略低于非进展组,但除ADC图(3000/1000)时两组间差别具有统计学意义外(P=0.023),其余ADC图中两种测量方法的最小ADC值和其相对值无明显差别(P值均>0.05)。两种测量方法获取的ADC值在鉴别肿瘤进展的曲线下面积相近。以ADC(3000/2000)图中r CADC_(mean)与FADC_(mean)ROC曲线下面积最大,其最佳阈值、敏感性、特异性、阳性预测值和阴性预测值分别为:rCADC_(mean):1.12、92.9%、77.4%、80.4%、91.6%;FADC_(mean):487.45 mm~2/s、89.3%、83.9%、84.7%、88.8%。结论以FLAIR为参照测量ADC值能有效界定胶质瘤治疗后近期肿瘤进展与非进展,其准确性与CET_1WI参照法的方法相当,提示FLAIR序列可替代CE-T_1WI作为胶质瘤治疗后评估ADC值测量的参照。
OBJECTIVE: To compare the difference between the ADC value of high b-value DWI imaging and the non-progression of gliomas after differentiating between glioma and glioma patients by using T-1WI (CE-T_1WI) and FLAIR sequence as reference. Methods 47 patients with continuous glioma postoperative chemoradiotherapy were treated with CET_1WI, FLAIR and multi-b value DWI before and after treatment (b = 1000, 2000, 3000 s / mm ~ 2) (3000/1000), ADC (3000/2000)]. A total of 59 cases of enhanced + FLAIR high signal lesions were observed in 47 cases. According to the RANO criteria, they were divided into progressive group (27 cases, 30 lesions) and non-progressive group (20 cases, 29 lesions). The mean ADC values (CADC_ mean and FADC_means) and the minimum ADC values (CADC_ (min) and FADC_ (min)) were measured in the corresponding areas of the two intensified and FLAIR high signals to calculate r ADC. Two independent samples t-test and Wilcoxon rank-sum test were used to compare the differences of ADC values between the two groups. ROC curve analysis was used to evaluate the efficiency of tumor progression. Results The average ADC value and its relative value (both methods) of progress group were lower than those of non-progress group (P <0.05). The minimum ADC value of the progressive group corresponding to the high signal area of CE-T 1WI and FLAIR was slightly lower than that of the non-progressing group, except for ADC (3000/1000), the difference between the two groups was statistically significant (P = 0.023) There is no significant difference between the minimum ADC values of the two measurement methods and their relative values (P> 0.05). The ADC values obtained by the two measurement methods are similar in area under the curve that identifies tumor progression. The area under rOCC (mean) and FADC mean (ROC) curves of ADC (3000/2000) showed the largest, and the best threshold, sensitivity, specificity, positive predictive value and negative predictive value were rCADC_ (mean) : 1.12, 92.9%, 77.4%, 80.4%, 91.6%; FADC mean: 487.45 mm ~ 2 / s, 89.3%, 83.9%, 84.7%, 88.8%. Conclusions The ADC value measured with FLAIR can effectively define the recent tumor progression and non-progression after glioma treatment. The accuracy of this method is comparable to that of the CET_1WI reference method, which indicates that the FLAIR sequence can be used as an alternative to CE-T_1WI for the evaluation of ADC Reference for value measurement.