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目的 探讨瘤体区及瘤周水肿区体素内不相干运动成像（IVIM）对不同级别弥漫性脑胶质瘤的鉴别诊断价值，并分析IVIM参数与肿瘤细胞增殖活性指标Ki-67指数的相关性。方法 选取经术后病理证实的弥漫性脑胶质瘤患者44例，其中病理分级Ⅱ级17例（低级别胶质瘤组）、Ⅲ级和Ⅳ级27例（高级别胶质瘤组）。于术前行IVIM检查，测量瘤体区、瘤周水肿区及对侧正常脑白质区的纯弥散系数（D）、伪弥散系数（D*）、灌注分数（f）以及相对纯弥散系数（rD）、相对伪弥散系数（rD*）、相对灌注分数（rf），比较两组各参数的差异。采用免疫组化法检测Ki-67指数。采用Spearman相关分析法分析Ki-67指数与IVIM各参数的相关性，采用ROC曲线评估IVIM各参数对高、低级别胶质瘤的鉴别诊断效能。结果 低级别胶质瘤组瘤体区rD、rf高于高级别胶质瘤组，rD*低于高级别胶质瘤组（P均<0.05）；低级别胶质瘤组瘤周水肿区rD高于高级别胶质瘤组，rD*低于高级别胶质瘤组（P均<0.05）。低级别胶质瘤组瘤体区与瘤周水肿区IVIM各参数比较差异均无统计学意义（P均>0.05）；高级别胶质瘤组瘤周水肿区rD高于瘤体区，rD*值低于瘤体区（P均<0.05）。与低级别胶质瘤比较，高级别胶质瘤的Ki-67指数升高（P<0.05）。瘤体区rD*、rf与Ki-67呈正相关（r分别为0.781、0.261,P均<0.05），瘤周水肿区rf与Ki-67呈正相关（r=0.294,P<0.05）。瘤体区rD*鉴别诊断高、低级别胶质瘤的AUC为0.855，高于其他参数。结论 IVIM能够无创性评估胶质瘤级别，其中瘤体区rD*鉴别诊断效能最优；瘤体区rD*、rf及瘤周水肿区rf与Ki-67指数相关，可无创性评估肿瘤细胞增殖活性，为临床制定精准及安全的手术切除范围提供参考。
Abstract：Objective To explore the value of intravoxel incoherent motion imaging(IVIM) related parameters in predicting tumor grading in diffuse gliomas and peritumoral edema areas, and its correlation with Ki-67 index expression. Methods A total of 44 diffuse glioma patients confirmed by postoperative pathology were selected. There were 17 cases of low-grade glioma and 27 cases of high-grade glioma. All patients underwent IVIM examination before operation, and IVIM post-processing was performed on the workstation. Three parameters of pure apparent diffusion coefficient(D), pseudo-apparent diffusion coefficient(D*), and perfusion fraction(f) were extracted. The tumor area, peritumoral edema area, and contralateral normal white matter area were selected as the regions of interest, and the measured values of each parameter were obtained. The measured values of the tumor parenchymal area and edema area were divided by the measured values of the contralateral normal white matter, and the corrected parameters were obtained, including relative pure diffusion coefficient(rD), relative pseudodiffusion coefficient(rD*), and relative perfusion fraction(rf). The differences between the HGG group and the LGG group were compared. The Ki-67 labeling index of patients was obtained by immunohistochemistry. Spearman correlation analysis was used to analyze the correlation between IVIM quantitative parameters and Ki-67 labeling index. ROC curve was used to evaluate the diagnostic efficacy of these parameters. Results The rD and rf values in the tumor area of the low-grade glioma group were higher than those in the high-grade glioma group, and the rD* value was lower than that in the high-grade glioma group(all P<0.05). The rD value of edema area in the low-grade glioma group was higher than that in the high-grade glioma group, the rD* value was lower than that in the high-grade glioma group(all P<0.05). There was no significant difference in rD value, rD* value and rf value between the tumor area and the edema area in the low-grade glioma group(all P>0.05). In the high-grade glioma group, the rD value of the edema area was higher than that of the tumor area, and the rD* value of the edema area was lower than that of the tumor(all P<0.05). Compared with low-grade gliomas, the Ki-67 labeling index of high-grade gliomas was higher(P<0.05). The rD* and rf values in the tumor area were positively correlated with Ki-67(r=0.781,0.261, P<0.05). The rf value in the edema area was positively correlated with Ki-67(r=0.294, P<0.05). The rD* in the tumor area had the largest AUC(AUC=0.855). Conclusion IVIM can non-invasively assess the grade of glioma, among which the rD* in the tumor area has the optimal discriminative efficacy. The Ki-67 index differs significantly between high-grade and low-grade gliomas, and the rD* and rf in the tumor area as well as the rf in the edema area are positively correlated with the Ki-67 index. This enables non-invasive evaluation of tumor proliferative activity and provides a reference for clinically formulating an accurate and safe surgical resection range.
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基本信息:
DOI：10.20258/j.cnki.1006-9011.2026.03.003
中图分类号:R739.41;R445.2
引用信息:
[1]王茹,谢生辉,高阳.体素内不相干运动成像对不同级别弥漫性脑胶质瘤的鉴别诊断价值及与Ki-67指数的相关性研究[J].医学影像学杂志,2026,36(03):13-18.DOI:10.20258/j.cnki.1006-9011.2026.03.003.
基金信息:
内蒙古自治区科技计划项目(编号:2019GG047)
2026-03-30
2026-03-30