脑胶质瘤MRI参数、微血管密度与预后的相关性研究^*

Study of the Correlation Between MRI Parameters, Microvascular Density, and Prognosis in Glioma

摘要

目的 分析多模态MRI检查参数〔表观弥散系数（ADC）、脑血流量（CBF）、胆碱（Cho）/肌酸（Cr）〕与脑胶质瘤患者微血管密度（MVD）的相关性及其对预后的评估价值。方法 回顾性分析2019年1月–2024年1月间在我院确诊为脑胶质瘤的200例患者病历资料，以WHO为分级基础，Ⅰ～Ⅱ级为低级别组（n=122）；Ⅲ～Ⅳ级为高级别组（n=78）；以预后情况为依据，分为预后良好组（n=114）和预后不良组（n=86）。Pearson相关性检验多模态MRI检查参数与脑胶质瘤MVD之间的关系，受试者工作特征曲线（ROC）的曲线下面积（AUC）评价多模态MRI检查参数以及MVD对高级别脑胶质瘤患者的诊断价值及其预后不良的预测价值，最后Hosmer-Lemeshow检查评估模型的拟合度。结果 低级别患者ADC值高于高级别组，CBF、Cho/Cr以及MVD均低于高级别组（P<0.05）。预后良好组患者ADC值高于预后不良组，CBF以及Cho/Cr值均低于预后不良组（P<0.05）。脑胶质瘤患者ADC与MVD呈负相关（r=-0.226，P=0.001）；CBF和Cho/Cr与MVD均呈正相关（r=0.235、0.396，P<0.001）。ADC、CBF、Cho/Cr、MVD诊断高级别脑胶质瘤患者的AUC分别为0.870、0.696、0.926、0.950，四者联合的AUC为0.997。多模态MRI检查参数对脑胶质瘤患者预后的ROC曲线中，DC+CBF+Cho/Cr联合预测的AUC为0.876，ADC、CBF、Cho/Cr单独诊断的AUC分别为0.718、0.688、0.808。Hosmer-Lemeshow检验显示ADC+CBF+Cho/Cr联合预测模型拟合度良好（χ²=8.570，P=0.380），即ADC+CBF+Cho/Cr联合预测模型具有较高的精确度。结论 ADC、CBF、Cho/Cr与脑胶质瘤患者MVD具有弱相关性，四者联合诊断高级别脑胶质瘤患者的价值较高，前三者联合对患者预后的预测价值较高。

Abstract

Objective To analyze the correlations between multimodal MRI examination parameters – apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and choline (Cho)/creatine (Cr)-and microvessel density (MVD) in patients with glioma, as well as the prognostic value of these parameters. Methods The medical records of 200 patients diagnosed with glioma at our hospital from January 2019 to January 2024 were retrospectively analyzed. According to the WHO classification, patients were divided into a low-grade group (n = 122) and a high-grade group (n = 78). Patients were further divided into a good prognosis group (n = 114) and a poor prognosis group (n = 86). The Pearson correlation test was used to analyze the relationship between multimodal MRI parameters and MVD in glioma patients. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of multimodal MRI parameters and MVD for high-grade glioma and their predictive value for poor prognosis. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results The ADC value in the low-grade group was higher than in the high-grade group, while CBF, Cho/Cr, and MVD were lower in the low-grade group (P < 0.05). The ADC value in the good prognosis group was higher than in the poor prognosis group, while CBF and Cho/Cr values were lower in the poor prognosis group ( P < 0.05). ADC was negatively correlated with MVD in glioma patients ( r = -0.226, P = 0.001); CBF and Cho/Cr were positively correlated with MVD (r = 0.235 and 0.396, P = 0.001 and < 0.001, respectively). The AUCs of ADC, CBF, Cho/Cr, and MVD for diagnosing high-grade glioma were 0.870, 0.696, 0.926, and 0.950, respectively. The combined AUC of these four parameters was 0.997. For prognosis prediction based on multimodal MRI parameters, the combined AUC of ADC+CBF+Cho/Cr was 0.876, while the AUCs of ADC, CBF, and Cho/Cr alone were 0.718, 0.688, and 0.808, respectively. The Hosmer-Lemeshow test showed that the combined model (ADC + CBF + Cho/Cr) fit was good ( χ² = 8.570, P = 0.380), indicating that the combined prediction model had high accuracy. Conclusion ADC, CBF, and Cho/Cr have a weak correlation with MVD in glioma patients. The combination of these four parameters has high value in diagnosing high-grade glioma, and the combination of the first three parameters has higher predictive value for patient prognosis.

关键词

多模态MRI / 脑胶质瘤 / 微血管密度 / 预后

Key words

Multimodal MRI / Brain glioma / Microvascular density / Prognosis

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基金资助

*兵团指导性科技计划项目(2022ZD032)