目的

探讨动脉自旋标记（ASL）技术对毛细胞型星形细胞瘤（PA）、血管母细胞瘤（HB）、髓母细胞瘤（MB）3种常见颅脑肿瘤患儿脑血流量（CBF）检测的临床应用价值。

方法

选择2015年4月至2024年7月于中国人民解放军总医院手术治疗后切除组织病理学检查被确诊为PA、HB、MB的35 例患儿为研究对象。采用回顾性分析方法，将其分别纳入PA 组（n=10）、HB 组（n=12）、MB组（n=13）。手术治疗前，对3组患儿均进行MRI平扫、增强及3D ASL成像，测量3组患儿肿瘤实质、近侧瘤周区（距离肿瘤强化边缘≤1 cm）、远侧瘤周区（距离肿瘤强化边缘＞1 cm）CBF值。采用单因素方差分析与Kruskal-Wallis H 秩和检验，对3 组患儿肿瘤实质、近侧与远侧瘤周区CBF值进行统计学比较。本研究遵循的程序符合2013 年修订的《世界医学协会赫尔辛基宣言》要求。

结果

PA 组、HB 组、MB 组患儿肿瘤实质CBF 值中位数分别为59.1、255.7、32.1 m L/（100 g·min），近侧瘤周区CBF 值分别为（62.3±30.0）、（196.3±113.6）、（39.6±17.5）m L/（100 g·min），远侧瘤周区CBF 值中位数分别为59.2、112.2、33.1 m L/（100 g·min），3组患儿肿瘤实质、近侧与远侧瘤周区CBF值分别总体比较，差异均有统计学意义（χ²=25.51、P＜0.001，F=18.00、P＜0.001，χ²=15.26、P＜0.001）。对3组患儿的上述数据进一步两两比较的结果显示，HB组肿瘤实质、近侧瘤周区CBF值，均分别显著高于PA 组、MB组，并且差异均有统计学意义（肿瘤实质CBF值：Z=-3.56、-4.13，均为P＜0.001；近侧瘤周区CBF值：均为P＜0.001）；而PA 组、HB组患儿远侧瘤周区CBF 值，则均分别显著高于MB 组，差异亦均有统计学意义（P=0.009、＜0.001）。

结论

ASL是一种磁共振灌注成像技术，可定量评估PA、HB、MB等3种儿童常见颅脑肿瘤患儿的CBF值，为PA、HB、MB鉴别诊断提供辅助参考。

Objective

To explore the application value of arterial spin labeling（ASL）in detecting cerebral blood flow（CBF）in children with three common intracranial tumors，namely pilocytic astrocytoma（PA），hemangioblastoma（HB），and medulloblastoma（MB）.

Methods

A total of 35 children who underwent surgical treatment in Chinese PLA General Hospital from April 2015 to July 2024 and were diagnosed with PA，HB，or MB by histopathological examination of the surgically resected tissues were selected as the research subjects.They were included into the PA group （n=10），HB group ^（n=12），and MB group ^（n=13）by retrospective analysis method.Before surgical treatment，all children in three groups underwent plain MRI scan，enhanced MRI scan，and 3D ASL imaging.The CBF values of the tumor parenchyma，proximal peritumoral area （within 1 cm from the enhanced edge of the tumor），and distal peritumoral area（more than 1 cm from the enhanced edge of the tumor）were measured in the three groups.One-way ANOVA and Kruskal-Wallis H rank sum test were used to statistically compare the CBF values of the tumor parenchyma，proximal and distal peritumoral areas among the three groups.The study protocol complied with the WorldMedical AssociationDeclarationofHelsinki revised in 2013.

Results

In PA group，HB group，and MB group，the median CBF values of the tumor parenchyma were 59.1，255.7，and 32.1 mL/（100 g·min），respectively，and the CBF values of the proximal peritumoral area were（62.3±30.0），（196.3±113.6），and（39.6±17.5）m L/（100 g·min），respectively，and the median CBF values of the distal peritumoral area were 59.2，112.2，and 33.1 m L/（100 g· min），respectively.There were statistically significant differences in the overall comparison of the CBF values of the tumor parenchyma，proximal and distal peritumoral areas among three groups （χ²=25.51，P＜0.001；F=18.00，P＜0.001； χ²=15.26，P＜0.001）.The results of further pairwise comparison showed that the CBF values of the tumor parenchyma and proximal peritumoral area in the HB group were significantly higher than those in PA group and MB group，and the differences were statistically significant（CBF values of the tumor parenchyma：Z=-3.56，-4.13，both P ＜0.001；CBF values of the proximal peritumoral area：both P ＜0.001）.The CBF values of the distal peritumoral area in PA group and HB group were significantly higher than those in MB group，and the differences were statistically s ignificant （P=0.009，＜0.001）.

Conclusions

ASL is a perfusion weight imaging technique，which can quantitatively evaluate the CBF values of three common intracranial tumors such as PA，HB，and MB，providing an auxiliary reference for the clinical differential diagnosis of PA，HB，and MB.