The Clinical Value Of Multimodal Magnetic Resonance In Preoperative Diagnosis And Evaluation Of The Biological Behavior Of Meningiomas

Part 1 The Analysis of the Clinical Value of 3D Pseudocontinuous Arterial Spin Labeling MR Imaging with Diffusional kurtosis Imaging in the evaluation of meningioma grades and subtypesPurpose: To investigate the clinical application value of magnetic resonance diffusion kurtosis imaging combined with whole brain three-dimensional spin labeling imaging technique for classification of high-grade and low-grade meningioma.Materials and Methods: A total of 94 patients who underwent neurosurgery in the neurosurgery of the top three hospitals and who required magnetic resonance imaging(MRI)were routinely collected and enhanced in 3T magnetic resonance within 7 days before surgery.Sequence,Diffusional kurtosis imaging(DKI)and Three dimensional arterial spin labelling(3D-ASL)examination.Calculate mean kurtosis(MK)and normalized mean kurtosis(n MK),axial kurtosis(KA)and normalized axial kurtosis(n KA),radial peaks Radial kurtosis(KR)and normalized radial kurtosis(n KR),fractional anisotropy(FA)and normalized fractional anisotropy(n FA),mean diffusion coefficient(mean)Diffusion,MD)and normalized mean diffusivity(n MD),cerebral blood flow(CBF),and normalized cerebral blood flow(n CBF)values.The standard parameter calculation method is the tumor parenchymal parameter / the contralateral normal brain white matter.Meningioma were classified into high-grade(WHO class II and WHO class III)and low-level group(WHOI class)according to the 2007 WHO neurological tumor classification principle.DKI and ASL single-modal series were used to classify meningiomas using a separate sample t test.DKI combined with ASL multimodality was used to classify meningioma by Binary logistic regression analysis,and the ROC curve was drawn to obtain the parameters of maximum diagnostic efficacy.One-way ANOVA was used to further classify the pathological subtypes of meningioma,and multiple comparisons were performed by LSD method and a box plot was drawn.The pathological specimens were evaluated for Ki-67 antigen expression by MIB-1 immunostaining,and the correlation between DKI and 3D-ASL parameters and pathological index ki-67 proliferation index was analyzed.Results: In this study,81 patients with low-grade meningioma and 13 patients in high-grade group were included in the study.The MK,n MK,n KA and n KR values of low-grade meningioma were significantly lower than those in the high-grade group(p<0.05).The n MD value of the tumor was lower than that of the low-grade group(p<0.05),and the area under the ROC curve of the n MK value was the largest(area under the ROC,AUC),indicating the highest diagnostic efficiency for meningioma grading,AUC,critical value,sensitivity,specificity.The 95% confidence intervals are: 0.887,1.01,92.3%,82.5%,and 0.761-0.993.Other DKI parameters were not statistically significant between the two groups;the ASL parameter CBF was not statistically different between the two groups.The standardized parameter n CBF was statistically different between the two groups,the area under the curve(AUC),critical value,sensitivity,Specificity and 95% confidence intervals were 0.802,2.945,92.9%,65.4%,and 0.709-0.894,respectively.The diagnostic efficiency of DKI combined with ASL multimodality for meningioma grading was significantly improved.The maximum AUC of n MK combined with n CBF was 0.921,and the sensitivity and specificity were 100% and 78.8%,respectively.It can be used as a non-invasive grading for meningioma.Non-invasive indicators.When DKI and ASL parameters were further classified into four pathological subtypes of meningiomas,there was a statistically significant difference in the ASL parameters n CBF between the four subtypes(p<0.05).LSD multiple comparison of angioma meningioma n CBF values and other non-vascular There are large statistical differences between tumor-type meningiomas.The ASL standard parameter n CBF can be used as an imaging index to distinguish between hemangiomas and non-angioma meningiomas.DKI parameters n FA can distinguish fibroid meningiomas and other pathological types of meningiomas.(p<0.05).DKI and ASL parameters n MD,n MK,n KA,n CBF,n KR and ki-67 showed significant linear correlation,among which n KR and n MK values were most obvious and linear positive correlation(n KR: r=0.693,p<0.001,n MK: r = 0.625,p < 0.001).Conclusion: DKI and ASL can help identify high-grade and low-grade meningiomas.When DKI is combined with ASL,it has more reference value for meningioma grading.And DKI and ASL can distinguish some types of meningioma.The parameters of DKI and ASL are linearly related,and DKI and ASL have some help in responding to tumor potential.Part 2 The Clinical value of 3.0T Magnetic Resonance Imaging 3D-CUBE T1 for the Preoperative Evaluation of Venous Sinus Invasion MeningiomaOBJECTIVE: To prospectively the diagnostic value of 3.0T magnetic resonance 3D fast spin-echo T1 black-blood magnetic resonance imaging(3D-CUBE T1)compara to Contrast-enhanced magnetic resonance venography,(CE-MRV)in the detection of sinus wall invasion and sinus patency in para-sinus meningiomas.MATERIALS AND METHODS: Forty-six patients with neurosurgery in the top three hospitals who were diagnosed as parasinus meningioma and requiring further MR examination were included.All patients underwent 3T magnetic resonance scan sequence,3D-CUBE T1 sequence,CE-MRV sequence and enhanced sequence examination before surgery.,and the time between magnetic resonance examination and surgical examination does not exceed 7 days.All patients underwent surgery.According to the relationship between meningioma and venous sinus,the parasinus meningioma is divided into 4 types(Type I: meningioma does not involve sinus;Type II: tumor only involves the sinus wall,does not invade the sinus cavity,venous sinus;Type III: meningioma invades the sinus,stenosis into the lumen with different degrees of sinus stenosis,the lumen is not blocked by the tumor;Type IV: the tumor completely blocks the sinus),the surgical results are the gold standard,compare 3D-The diagnostic accuracy of CUBE T1 and CE-MRV,and the clinical value of 3D-CUBE T1 and CE-MRV for the classification of various paranasal meningiomas.RESULTS: Forty-six patients with brain tumors were located next to the sinus and 43 patients with sinus meningioma.The preoperative 3D-CUBE T1 and CE-MRV images were judged by two imaging surgeons respectively,and the 3D-CUBE T1 group was consistent.(Kappa = 0.91)was better than the CE-MRV group(Kappa = 0.82)(p < 0.05).With the surgical results as the gold standard,the accuracy of 3D-CUBE T1 and CE-MRV for meningioma typing was 90.1% and 79.1%,respectively.The accuracy of 3D-CUBE T1 typing was better than CE-MRV,in 4 types.Among them,the accuracy of 3D-CUBE T1 was better than CE-MRV and the sensitivity,specificity,positive and negative predictive value of 3D-CUBE T1 in each type were also better than CE-MRV.Especially for the new 4 types,the diagnosis of type I and type II para-sinus meningioma by 3D-CUBE T1 greatly compensated for the limitations of CE-MRV.Conclusion: 3.0T magnetic resonance 3D-CUBE T1 diagnosis of sinus meningioma classification and surgical results are consistent with CE-MRV,in the evaluation of the location and extent of sinus paraventricular tumor invasion of sinus,3.0T magnetic resonance 3D-CUBE The accuracy of the T1 sequence is also better than that of CE-MRV.Therefore,3D-CUBE T1 is superior to CE-MRV for preoperative evaluation of sinus meningioma,and the sinus meningioma is divided into 4 types.The guiding role is clearer and has better clinical value.