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目的:探讨合成MRI联合三维动脉自旋标记（3D-ASL）成像对弥漫性胶质瘤分级诊断的应用价值及与肿瘤细胞增殖活性（Ki-67）的相关性。方法:本研究为前瞻性研究。分析2020年8月至2021年6月在宁夏医科大学总医院接受颅脑合成MRI和3D-ASL成像的66例弥漫性胶质瘤患者的临床及影像表现。66例患者中男36例、女30例，年龄4~76岁，分为低级别胶质瘤（LGG）组25例（WHO Ⅱ级）和高级别胶质瘤（HGG）组41例（WHO Ⅲ、Ⅳ级）。利用GE ADW4.7后处理软件测量肿瘤实质部分Tn 1、Tn 2、质子密度（PD）、脑血流量（CBF）。术后病理切片通过免疫组化检测Ki-67标记指数（Ki-67 LI）。采用独立样本n t检验或Mann-Whitney n U检验比较HGG组与LGG组各定量参数的差异，采用受试者操作特征（ROC）曲线分析Tn 1、PD、CBF和三者联合的诊断效能，利用Spearman检验分析各参数与Ki-67 LI的相关性。n 结果:HGG组Tn 1［（1 573±173）ms］、PD［（86.2±2.4）pu］、CBF［（129±48）ml·100 gn -1·minn -1］均高于LGG组［分别为（1 376±134）ms、（83.0±2.5）pu、（77±49）ml·100 gn -1·minn -1］，差异具有统计学意义（n t分别为-4.86、-5.08、-4.24，n P<0.01）。ROC显示Tn 1、PD、CBF鉴别HGG与LGG的曲线下面积（AUC）分别为0.847、0.843、0.777。多参数分析中，三者联合的诊断效能最高（AUC=0.973），灵敏度和特异度分别为87.8%和100%。在LGG和HGG组中，Tn 1、Tn 2、PD、CBF与Ki-67 LI无相关性；整体胶质瘤患者中，Tn 1、PD、CBF与Ki-67 LI呈正相关性（n r分别为0.394、0.411、0.406，n P<0.01）；Tn 2与Ki-67 LI无相关性（n r=-0.100，n P=0.423）。n 结论:合成MRI和3D-ASL可无创评估弥漫性胶质瘤的病理分级并预测Ki-67 LI，其中Tn 1和PD是较好的影像学新指标。n “,”Objective:To evaluate the value of synthetic MRI combined with three dimensional-arterial spin labeling (3D-ASL) imaging in the grading of diffuse glioma and its correlation with tumor cell proliferative activity (Ki-67).Methods:This study was prospective. The clinical and imaging manifestations of 66 patients with diffuse glioma who underwent synthetic MRI combined with 3D-ASL imaging from August 2020 to June 2021 in General Hospital of Ningxia Medical University were analyzed. Among 66 patients, there were 36 males and 30 females, aged 4-76 years, and divided into low grade glioma (LGG) group (n n=25) (WHO Ⅱ) and high grade glioma (HGG) group (n n=41) (WHO Ⅲ and vⅣ). Tn 1, Tn 2, proton density (PD) and cerebral blood flow (CBF) of tumor parenchyma were measured by GE ADW4.7 postprocessing software. The Ki-67 label index (Ki-67 LI) in postoperative pathological sections was detected by immunohistochemistry. Independent sample n t test or Mann-Whitney n U test was used to compare the differences of quantitative parameters between HGG group and LGG group. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of Tn 1, PD, CBF and the combination. Spearman test was used to analyze the correlation between the parameters and Ki-67 label index (LI).n Results:Tn 1[(1 573±173)ms], PD[(86.2±2.4)pu] and CBF[(129±48)ml·100 gn -1·minn -1] in HGG group were significantly higher than those in LGG group [(1 376±134)ms, (83.0±2.5)pu and (77±49)ml·100gn -1·minn -1 respectively], and difference had statistical significance (n t=-4.86, -5.08, -4.24, n P<0.01). ROC confirmed that the area under curve (AUC) of Tn 1, PD and CBF in differentiating HGG from LGG were 0.847, 0.843 and 0.777, respectively. In multi-parameter analysis, the combination of three parameters had the best diagnostic efficiency (AUC=0.973) and the sensitivity and specificity were 87.8% and 100%, respectively. In LGG and HGG groups, there was no correlation between Tn 1, Tn 2, PD, CBF and Ki-67 LI. In the overall cohort, Tn 1, PD and CBF had slight positive correlation with Ki-67 LI (n r=0.394, 0.411 and 0.406, respectively, alln P<0.01). There was no correlation between Tn 2 and Ki-67 LI (n r=-0.100, n P=0.423).n Conclusion:Synthetic MRI and 3D-ASL can noninvasively evaluate the pathological grade of glioma and predict the expression of Ki-67, among which Tn 1 and PD are novel imaging marks.n