Application of magnetic resonance imaging assessment of pathological grade astrocytic tumors studied

Title: Application of magnetic resonance imaging assessment of pathological grade astrocytic tumors studied Author: Bai Xu Degree-granting units: Tianjin Medical University Key words: perfusion-weighted imaging;; diffusion-weighted imaging;; the highest rCBV value;; minimum ADC value;; highest ADC_ (difference);; MRI;; astrocytomas Abstract:
The first part
Application of MR perfusion-weighted imaging (PWI) assess the pathological grade of astrocytic tumors studied
Objective: To evaluate magnetic resonance perfusion-weighted imaging (perfusion weighted imaging, PWI) for preoperative tumor grade astrocytomas value. Subjects and Methods: Analysis of 110 cases with pathologically confirmed supratentorial astrocytic tumors in real terms, all patients were in preoperative Siemens 1.5T MRI system routine MRI scan and check-enhanced MRI and PWI. According to the World Health Organization (WHO) classification of Neodymium Magnets central nervous system tumors and grading criteria: 110 cases of astrocytic tumors, low-level (Ⅰ ~ Ⅱ) tumors in 40 cases, high-level (Ⅲ ~ Ⅳ grade) tumors 70 cases (of which Ⅲ grade tumors 33 cases, Ⅳ grade tumor 37 cases). In the post-processing workstation to obtain pseudo-color pictures PWI CBV checks, application hotspot analysis, ROI detection of tumors by placing the solid part and the maximum rCBV values ​​of peritumoral area, and the corresponding parts of the contralateral normal white matter CBV values ​​as an internal reference standard calculate the maximum rCBV values. Maximum rCBV values ​​of different grade tumors compared using analysis of variance, pairwise comparisons using the LSD method; between the two groups using t test; draw the ROC curve to determine the identification of high-level and low level of astrocytic tumors of the highest rCBV values ​​of the ideal threshold test level α = 0.05. Results: The solid part of the astrocytomas with the highest rCBV value of a positive linear correlation pathological level, Ⅰ - Ⅱ level, Ⅲ and Ⅳ tumors Grade highest rCBV values ​​were 1.708 ± 0.535,4.207 ± 0 .808 and 6.693 ± 1.220, the difference between the various levels were significant (all P = 0.000); high-level solid part of the astrocytomas was significantly higher than the maximum rCBV values ​​of low-grade tumors (P = 0.000). Astrocytomas peritumoral areas with the highest rCBV values ​​of linear correlation was also found pathological level, the difference between the same levels of statistical significance (all P = 0.000). Compared to the solid part of the astrocytomas the highest rCBV value standard for assessing tumor grade, is superior to peritumoral has the highest rCBV value assessment results. Solid part of the tumor to identify the highest rCBV value high-level and low level of astrocytic tumors, the area under the ROC curve obtained A_z value of 0.993 to 2.618 as the ideal threshold, the sensitivity of 98.60% and a specificity of 95.00%. Conclusion: PWI check astrocytic tumors obtained CBV map to reflect changes in tumor blood volume, and tumor blood volume changes in the solid part of its pathological grade is a positive linear correlation, so that by detecting and calculating the maximum rCBV value, will be able to assess http://www.everbeenmagnet.com/en/products/110-sintered-neodymium-magnets the pathological level. PWI examination for preoperative evaluation of the pathological grade astrocytomas have a higher value.
The second part
Application of MR diffusion-weighted imaging (DWI) assess the pathological grade of astrocytic tumor ADC values ​​and Ki-67 index of correlation
Objective: To evaluate diffusion-weighted imaging (diffusion weighted imaging, DWI) for the preoperative tumor grade astrocytomas value, and analyze the minimum ADC value of tumor Ki-67 labeling index and the correlation. Subjects and Methods: The subjects with the first part. All patients were on preoperative magnetic resonance imaging system Siemens1.5T routine MRI scan and check-enhanced MRI and DWI. In the post-processing workstation to obtain ADC map. By placing the ROI method, were used to detect the amount of solid tumor and peritumoral areas part of the minimum ADC value. Pathological sections were Ki-67 immunohistochemistry, Ki-67 labeling index determination, analysis of solid tumor parts with the lowest ADC value of the correlation. Solid part of the different levels of the tumor and peritumoral area than the lowest ADC values ​​between groups were compared using analysis of variance, pairwise comparisons using the LSD method; different levels of tumor Ki-67 labeling index using rank test; between the two groups using t test; draw the ROC curve to determine the identification of high-level and low level solid part of the astrocytomas the minimum ADC value of the ideal threshold. Solid part of the astrocytomas minimum ADC value and Ki-67 using Pearson correlation analysis between the linear method. Standard statistical tests α = 0.05. Results: The solid part of the astrocytomas and its pathological grade minimum ADC value was significantly negatively correlated, Ⅰ ~ Ⅱ grade, Ⅲ and Ⅳ grade astrocytomas grade solid part of the minimum ADC values ​​were 1.400 ± 0.162 × 10 ~ (-3) mm ~ 2 / s, 1.067 ± 0.146 × 10 ~ (-3) mm ~ 2 / s and 0.854 ± 0.160 × 10 ~ (-3) mm ~ 2 / s, different levels of tumor solid part of the difference between the minimum ADC value was statistically significant (P = 0.000). Astrocytomas peritumoral area and pathology of the minimum ADC value was also found a significant negative correlation levels, different levels of tumor tumor-week low ADC values ​​were significantly different between the same (P = 0.000). Analysis showed that the solid part of the tumor and peritumoral areas for assessment of the minimum ADC value astrocytic tumor grade has a similar effect. Solid part of the tumor to identify the minimum ADC value of high-level and low level of astrocytic tumors, the area under the ROC curve obtained A_Z value of 0.963 to 1.196 × 10 ~ (-3) mm ~ 2 / s as ideal threshold value, the sensitivity of 90.60%, specificity 84.30%. Immunohistochemical analysis, between the pathological grade of tumor Ki-67 labeling index were significantly different (P = 0.000); tumor Ki-67 labeling index and the fact of some of the lowest ADC value was significantly negatively correlated (r =- 0 .754, P <0.05) Conclusion: astrocytomas DWI examination acquired ADC maps reflect the tumor extent of movement of water molecules is limited, while the solid part of the water molecules in the tumor extent is limited by its pathological grade was significantly negative correlation, so by detecting the minimum ADC value, will be able to assess the pathological level. Some solid tumors but also to reflect the minimum ADC value of Ki-67 expression, this technology can be used to prompt further preoperative evaluation of the pathological grade astrocytic tumors.
The third part
Comparison and combination of MR PWI, DWI check astrocytic tumor grade assessment study
Objective: assess the level of astrocytic tumor pathology highest rCBV values ​​of the parameters of the lowest ADC values ​​and the correlation, and comparison and combination of PWI, DWI check the level of performance assessment of tumor pathology. Subjects and Methods: The subjects and methods of the same first and second parts. Were drawn up the solid part of the tumor rCBV values ​​and the lowest ADC values ​​to identify high-level low-grade astrocytomas with the ROC curve to compare the area under the curve A_Z value, test level α = 0.05. Results: The assessment of high-level (Ⅲ ~ Ⅳ grade) astrocytomas, the most solid part of tumor rCBV values ​​between the minimum ADC values ​​were negatively correlated (r =- 0.338, P = 0.004); and in assessment of low-level (Ⅰ ~ Ⅱ grade) astrocytomas, the tumor rCBV values ​​of the solid part of the highest and the lowest no correlation between ADC values ​​(r = 0.131, P = 0.419). Application of solid tumors to identify some of the highest rCBV value of high-level (Ⅲ ~ Ⅳ grade) and low level (Ⅰ ~ Ⅱ grade) astrocytic tumors, ROC area under the curve value of 0.993 A_Z, when the selected threshold value of 2. 618, the receive sensitivity of 98.60%, specificity 95.0%. Application of solid tumors to identify some of the lowest ADC value of high-level (Ⅲ ~ Ⅳ grade) and low level (Ⅰ ~ Ⅱ grade) astrocytic tumors, ROC area under the curve value of 0.963 A_Z, when the selected threshold value of 1. 196 × 10 ~ (-3) mm ~ 2 / s, identification of high-grade tumors obtained 90.00% sensitivity and specificity of 84.30%. The same part of the joint solid tumors with the highest rCBV value of the minimum ADC value astrocytic tumor grade assessment, according to the first and second part of the chosen ideal threshold 2.618 and 1.196 × 10 ~ (-3 ) mm ~ 2 / s as standard, the sensitivity obtained was 82.9%, specificity of 97.50%. Conclusion: As a low-level and high-level assessment of astrocytic tumor marker, the solid part of the high-grade tumors the highest rCBV values ​​and the lowest ADC values ​​has a negative correlation. Identification of high-level and low level of astrocytic tumors, the solid part of the tumor according to the highest rCBV values ​​obtained diagnostic results were better than the lowest ADC values. Compared with a single indicator, combined with solid tumor rCBV values ​​of some of the highest and lowest ADC values ​​as a standard, does not improve the identification of high-grade tumors, but this combined method still has its clinical value.
Part IV
Application of MR diffusion-weighted imaging (DWI) ADC value of the difference between the assessment of pathological grade of astrocytic tumors studied
Objective: To evaluate the different b-value diffusion-weighted imaging (DWI) of the ADC value of the difference (ADC_ (difference)) methods to evaluate the astrocytic tumor grade value. Subjects and Methods: A prospective study of 33 cases of pathologically confirmed supratentorial astrocytic tumors in real terms, all patients were evaluated before the application for Siemens 3.0T conventional MRI, PWI and multi-b value DWI examination. 33 cases of astrocytic tumors, low-level (Ⅰ ~ Ⅱ) in 8 patients, high-level (Ⅲ ~ Ⅳ grade) in 25 cases (10 cases in which tumor grade Ⅲ, Ⅳ grade tumor 15 cases). On the workstation, respectively, for different b values ​​of ADC maps, the b value of 0,50 s / mm ~ 2 of the ADC map data minus the b value of 0,3000 s / mm ~ 2 of the ADC map data to be reflected in the data during difference ADC_ (difference) pseudo-color pictures. In reference to plain and enhanced conventional MRI examination on the basis of performance in ADC_ (difference) map, select the solid part of the tumor signal intensity on behalf of the gradation of the highest placed part of ROI. Different levels of tumor ADC_ (difference) were compared using analysis of variance, pairwise comparisons using Dunnett T3 method; between the two groups using t test. Correlation analysis using Pearson linear correlation method. Test level α = 0.05. Results: Ⅰ ~ Ⅱ grade, Ⅲ and Ⅳ grade astrocytic tumor grade the highest ADC_ (difference), respectively (0.91 ± 0.07) × 10 ~ (-3) mm ~ 2 / s, (1.81 ± 0.38) × 10 ~ (-3) mm ~ 2 / s and (2.36 ± 0.32) × 10 ~ (-3) mm ~ 2 / s, the pathological grade astrocytomas the solid part highest ADC_ (difference) there was a significant difference (F = 59.336, P = 0.000). Low-level (Ⅰ ~ Ⅱ grade) and high-level (Ⅲ ~ Ⅳ grade) tumors among the highest ADC_ (difference) is also a significant difference (t =- 7.907, P = 0.000). Astrocytic tumors of the pathological level and in fact some of the highest ADC_ (difference) has a significant positive correlation. High-level (Ⅲ ~ Ⅳ grade) astrocytomas solid part of the highest ADC_ (difference) and the maximum rCBV values ​​of the tumor has a significant positive correlation (r = 0.829, P = 0.000), and in the low-level ( Ⅰ ~ Ⅱ grade) tumor is no significant correlation (r = 0.259, P = 0.536). Conclusion: This article was first raised at home and abroad to apply a different b value ADC_ (difference) method to assess the pathological grade astrocytic tumors. Application of small b value (50 s / mm ~ 2) and large b value (3000 s / mm ~ 2) obtained ADC_ (difference) can provide tumor microcirculation information. Different pathological grade astrocytomas solid part of the highest ADC_ (difference) are different, so this method can be used for preoperative evaluation of tumor pathological grade. ADC_ (difference) screening method has its corresponding theoretical foundation, and the operation is simple, easy, and quick access to results, which is expected to become parts of the body lesions of microcirculation of a new screening technology. Degree Year: 2009