【摘要】 目的 探讨128层螺旋CT全脑灌注成像在脑胶质瘤术前分级与术后随访中的应用价值。方法 收集在本院经手术病理诊断且临床资料完整的74例胶质瘤患者，根据病理结果将其分为低级别组（Ⅰ～Ⅱ级）40例和高级别组（Ⅲ～Ⅳ级）34例，分别在术前及术后1个月行CT灌注扫描。选取肿瘤病灶区、肿瘤边缘区及术后残腔边缘区和健侧对应部位正常脑组织计算肿瘤组织血流灌注状态的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和毛细血管表面通透性（PS）,计算上述指标的相对值。比较各组间不同CT灌注参数差异，采用受试者工作特征曲线（ROC曲线）分析CT灌注参数诊断胶质瘤的敏感性和特异性。结果 正常脑组织CBF、CBV和PS参数均显著低于病灶区（P<0.05）。低级别组病灶区CBF、CBV、PS、相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对毛细血管表面通透性（rPS）均显著低于高级别组（P<0.05）。而MTT和相对平均通过时间（rMTT）在2组间无统计学差异（P>0.05）。CBF、CBV、PS对诊断高级别胶质瘤的曲线下面积分别为0.92,0.89和0.85（P<0.05）。取CBF=47.14 mL·100 g^-1·min^-1,CBV=8.09 mL/100 g, PS=17.76 mL·100 g^-1·min^-1对诊断高级别与低级别胶质瘤敏感性为89.3%,82.4%和80.0%,特异性为80.3%,77.0%和79.5%（P<0.05）。术后1年，复发组患者CBF、CBV、PS、rCBF、rCBV、rPS参数均显著高于未复发组（P<0.05）。结论 128层螺旋CT灌注成像参数能够反映不同级别胶质瘤的血流灌注状况，为胶质瘤的术前分级及术后复发提供有价值的信息。更多还原

【Abstract】 Objective To explore the application value of the 128-slice spiral CT whole brain perfusion imaging in preoperative grading and postoperative follow-up of gliomas.Methods 74 patients diagnosed with glioma by pathological data and clinical data were divided into low-grade group（Ⅰ-Ⅱ,40 cases） and high-grade group（Ⅲ-Ⅳ, 34 cases）.Cerebral blood flow（CBF）,cerebral blood volume（CBV）,mean transit time（MTT）,permeability surface（PS）,and the relative values of the above indexes were observed in tumor lesion area, tumor margin area and postoperative residual cavity margin area and healthy side normal brain tissue by CT perfusion scans.Differences of CT perfusion parameters between different groups were compared and the sensitivity and specificity of CT perfusion parameters were analyzed by ROC curve.Results CBF, CBV and PS parameters were significantly lower in the normal brain tissue than those in the lesion site（P<0.05）. CBF, CBV, PS, rCBF, rCBV and rPS in the low-grade group were significantly lower than those in the high-grade group（P<0.05）. There was no significant difference in MTT and rMTT between the two groups（P>0.05）. The area under the curve of CBF, CBV and PS for diagnosing high grade gliomas were 0.92, 0.89 and 0.85（P<0.05）, respectively.The sensitivity of CBF was 47.14 mL·100 g^-1·min^-1,CBV was 8.09 mL/100 g and PS was 17.76 mL·100 g^-1·min^-1 for diagnosing high-grade and low-grade gliomas were 89.3%, 82.4% and 80.0%, specificity were 80.3%, 77.0% and 79.5%（P<0.05）. The CBF, CBV, PS, rCBF, rCBV and rPS parameters of the patients with recurrence group were significantly higher than those with non-recurrence group（P<0.05）.Conclusion 128-slice spiral CT perfusion imaging parameters can reflect the perfusion status of different grades of gliomas, and can provide valuable information for preoperative classification and postoperative recurrence of glioma.更多还原