Astudy Of MRI3D-Pseudocontinuous Arterial Spin Labeling In Brain Gliomas Microenvironment Perfusion

Object:1. To explore characteristics of microenvironment perfusion of different gradebrain gliomas by3D-PCASLwith high-magnetic field（3.0T）MR system.2. Evaluate the value of3D-PCASLin the pre-operation brain gliomas grading.Methods:1. Fourty-one patients with gliomas (23male，18female; mean age,40.5years),According to World Health Organization(WHO)2007classification of centralnervous system, I-II grade is low grade, and III-VI grade is classification as highgrade,21high grade and20low grade was underwent3D-PCASL and conversionalMRI, included T1WI, T2WI, T2flair, DWI and enhancement.2. Solid region of tumor, one and two centimeters region of peri-tumor, oppositenormal gray matter and white matter CBF was measured respective, the size of eachregion of interest（ROI）was subter to50mm2，take the mean value respective.3.After data conversion, got TBF/opposite gray matter and white matter rCBF.4. All date recorded as(mean±standard deviation). Comparing the TBF, one andtwo centimeters region of peri-tumor CBF and rCBF in differences of high andlow-grade gliomas, and two independent-samples student test was used. P<0.05considerd statistically significant.5. One-way ANOVA was used between differences regions in same gradegliomas, P<0.05considerd statistically significant.6. According to the characteristics of conversional MRI cyst formation ornecrosis (one score), hemorrhagic (one score), signal strength of DWI(same or lowsignal0score, high signal1score) and the extent of contrast enhancement(nocontrast0,light1score,medium2scores and markedly3scores), a conversional MRIsocre was got. Used two independent-samples student test to comparing conversionalMRI socre between differences of high and low-grade gliomas, P<0.05considerdstatistically significant. 7. Between high and low-grade gliomas, if P<0.05，the best classificantionthreshold was found by analyzing ROC curve and then calculating its sensitivity andspecificity.8. All patients with gliomas was graded by radiologist by double blind on thebasis of conventional MRI, and then on the basis of conventional MRI+ASL, usedpared-sample χ2test analysis, P<0.05considerd statistically significant.Results：1．Comparison of high and low grade TBF、one and two centimeters region ofperi-tumor， independent-samples student test display:①High and low grade TBF were183.43±63.70ml/min/100g and80.80±33.00ml/min/100g，t=-6.428，P<0.001；one centimeters region of peri-tumorwere56.54±16.38ml/min/100g and37.14±9.33ml/min/100g，t=-4.628，P<0.001,bothof them had statistically significant.②Two centimeters region of peri-tumor were32.30±11.90ml/min.100g and33.49±10.35ml/min/100g,t=0.339,P=0.736,it has no statistically significant.2. Comparison of high and low grade TBF rCBF：TBF/opposite gray matter were2.86±0.90and1.25±0.40，t=-7.35，P<0.00, andTBF/opposite white matter rCBF were5.82±1.79and2.76±1.29,t=-6.23，P<0.001,both of them had statistically significant.3. On one-wayANOVA:High-grade gliomas all of them had its statistically significant between differencesregion(P<0.001). Low-grade gliomas except1cm and2cm of peri-tumor had nostatistically significant(P=0.544), and others region had statistically significantbetween differences region(P<0.001).4. Conversional MRI analysis:①MRI scan：cyst formation or necrosis were37cases in total, proportion of90%, high grade were21cases， proportion of51%, low grade were16cases，proportion of39%; Hemorrhagic were12cases in total, proportion of29%, highgrade were7cases，proportion of17%, low grade were5cases，proportion of12%.②DWI： Same or low signal were cases in total11, proportion of27%, highgrade were4cases，proportion of10%, low grade were7cases，proportion of17%; High signal were30cases in totall, proportion of73%, high grade were17cases，proportion of41%, low grade were13cases， proportion of32%.③Contrast enhancement scan： No contrast were6cases in totall, proportion of15%, high grade were0cases, low grade were6cases， proportion of15%;Lightcontrast were6cases in totall, proportion of15%, high grade were2cases, proportionof5%,low grade were4cases， proportion of10%; Medium contrast were8cases intotall, proportion of20%, high grade were3cases, proportion of7%,low grade were5cases， proportion of13%; Markedly contrast were21cases in totall, proportion of51%, high grade were16cases, proportion of39%,low grade were5cases，proportion of13%.④High and low grade conversional MRI socre were4.86±1.15and3.3±1.38,ithad statistically significant(t=-3.928，P<0.001).5. ROC curve analysis display:①After date conversion in TBF/opposite gray matter, it had the largest areaunder the curve with0.96, when threshold of rCBF chosen2, with the highestsensitivity(85.7%) and specificity(100%).②ACU of TBF was0.95，when threshold chosen115.19,with sensitivity(85.7%)and specificity(90%).③ACU of one centimeters region of peri-tumor was0.86，when thresholdchosen54.3, with sensitivity(61.7%) and specificity(100%).④ACU of two centimeters region of peri-tumor was0.44,when thresholdchosen30.05, with sensitivity(57.1%) and specificity(40%).⑤AUC of TBF/opposite whiter matter was0.92, when threshold chosen4.65,with sensitivity(76.2%) and specificity(90%).⑥AUC of conversional MRI was0.789, when threshold chosen4.5, withsensitivity(66.7%) and specificity(85%).6. On the pared-sample χ2test:Basis of conventional MRI with accurate rate76%, when basis of MRI+ASL,with the accurate rate93%, it has statistically significant(χ2=4.48, P=0.03) betweentwo methods.（χ2=6.61，P=0.01）。Conclusion: 3D-PCASLwith high-magnetic field（3.0T）MR system can accurate reflectionthe characteristics of microenvironment perfusion of different grade brain gliomas,rCBF had a higher sensitivity and specificity compare with others parameters, basisof conventional MRI+ASL can contribute to improve the accuracy of diagnosis.Moreover, our study had displayed a more tumor invasion extent in high-gradegliomas peri-tumor than low-grade gliomas, and it was provided a directed evidencefor surgical resection.