The Application Of 3DASL And Gd-DTPA Enhancement In The Identification Of Glioma Recurrence And Radiation-Induced Brain Injury

ObjectiveTo analyze the results of 3DASL and Gd-DTPA enhanced scan,and to explore the value of 3DASL and Gd-DTPA enhanced scan in the identification of glioma recurrence and radioation-induced brain injury.Materials and methodsThe clinical data and MRI findings of 40 patients with glioma after postoperative radiotherapy were analyzed.All patients showed abnormal enhancement in Gd-DTPA enhanced scan during follow-up.And confirmed by reoperation pathology or follow-up.16 cases of postoperative recurrence of tumor and 24 cases of radioation-induced brain injury.All patients underwent Gd-DTPA enhanced scan,DWI and 3DASL examination on GE 750 W 3.0T superconducting magnetic resonance scanner.Application of SPSS 20 statistical software for data analysis.Post processing of 3DASL related data on GE AW 4.5 workstation and get the corresponding color maps of cerebral blood flow by using a workstation with "Functool9.4.05" software.According to the results of Gd-DTPA enhanced scan,3 regions of interest(ROI)were animated in hand animation,including the central area of the foci,the edge area of the foci and the symmetrical area of the central area of the enhanced foci.Each location was measured 3 times on average,obtained the average CBF value of corresponding parts and calculated the average rCBF value of the central area of the enhanced focus,that is the CBF ratio of the central area of the foci and the symmetrical area.The application of SPSS 20 statistical software for data analysis,for the 3DASL image,the two independent samples t test was used to compare the same area between the recurrent group and the injury group.And draw corresponding ROC curves for statistically significant indicators,calculate the maximum Youden index,we find the best diagnostic threshold and calculate their sensitivity,accuracy and specificity respect-tively.The method of chi square test was used to Counting data,such as the shape of the foci,the maximum width of the foci,the area of the enlargement of the foci before and after the radiotherapy,whether have new focus,whether crossing of the middle line,whether invasion of the corpus callosum on the conventional enhanced images.Results1 Gd-DTPA enhancement examinationRelapse group:The shape of enhanced focus was 6 cases of annular enhancement,5 cases of lumpy enhancement,5 cases of patchy enhancement;15 cases with maximum width of foci≥ 5mm,1 cases of maximum width of foci<5mm;15 cases of intensification of the area before and after radiotherapy≥20%,1 cases of intensification of the area before and after radiotherapy <20%;6 cases crossing the middle line,10 cases not crossing the middle line;14 cases of corpus callosum invasion,2 cases without callosal invasion;10 cases have new foci,6 cases have no new foci.Injury group:The shape of enhanced focus was 3 cases of annular enhancement,4 cases of lumpy enhancement,5 cases of flaky enhancement,12 cases of linear enhancement;6 cases with maximum width of foci ≥ 5mm,18 cases of the maximum width of foci <5mm,7cases of intensification of the area before and after radiotherapy≥ 20%,17 cases of intensification of the area before and after radiotherapy <20%;4 cases across middle line,20 cases not crossing middle line;4 cases of corpus callosum invasion,20 cases without callosal invasion;3 cases have new foci and 21 have no new lesions.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the maximum width of foci ≥ 5mm,intensification of the area before and after radiotherapy≥ 20%,the invasion of the corpus callosum,and have new foci for the diagnostic tumor recurrence were respectively93.75%(15/16)、75%(18/24)、82.5%(33/40)、71.43%(15/21)、94.74%(18/19);93.75%(15/16)、70.83%(17/24)、80%(32/40)、68.18%(15/22)、94.44%(17/18);87.5%(14/16)、83.33%(20/24)、85%(34/40)、77.78%(14/18)、90.91%(20/22);62.5%(10/16)、87.5%(21/24)、77.5%(31/40)、76.92%(10/13)、(21/27).2.3DASL perfusion imagingThe average CBF of the foci center in the relapse group was 129.717 ±28.583,the average CBF of the lesion center was 38.933± 24.900,the average rCBF of the foci center in the relapse group was 3.877± 2.443,the average rCBF of the lesion center was 1.281± 0.741.In the recurrent group,the mean CBF of the edges of the enhanced foci was 26.671±7.586,and the average CBF of the lesions in the injured group was 21.083± 6.906.According to the ROC curve,calculated the maximum value of the Jordan index.According to this,the best diagnostic boundary value for the identification of recurrence and damage is found.The average CBF value of the focal area and the average rCBF value of the focal area are 0.992 and 0.969.The best diagnostic value of the average rCBF value of the central area of the focal area are 91.278 and 2.114,the sensitivity,specificity and accuracy of identifying the recurrence and injury are respectively100%(16/16),95.8%(23/24),97.5%(39/40);100%(16/16),87.5%(21/39),92.5%(37/40).Conclusion1 Gd-DTPA enhanced scanThe shape of the foci,the maximum width of the foci and the enlargement of the foci before and after the radiotherapy,the new focus or the invasion of the corpus callosum in the two groups were different,and the difference between the two groups was not statistically significant.Gd-DTPA enhanced scan has important clinical guiding value in differentiating postoperative recurrence and radiation brain injury of glioma.2.3DASL perfusion imagingThe average CBF value and the average rCBF value of the focal center were significantly higher in the recurrent group than the injury group(P<0.05),and the average CBF on the edge of the foci was slightly higher in the recurrent group than that in the injury group,and the difference was not statistically significant(P>0.05).3DASL has important clinical value in differentiating recurrent glioma from postoperative radiotherapy and radiation brain injury.