磁共振波谱在星形细胞肿瘤术前分级中的价值  

Clinical Value of MR Spectroscopy in Preoperative Grading of Astrocytic Tumors

作　　者：于同刚[1] 戴嘉中[1] 钱慧君[2] 冯晓源[1] 

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]复旦大学附属妇产科医院放射科

出　　处：《实用放射学杂志》2010年第1期1-6,共6页Journal of Practical Radiology

摘　　要：目的研究磁共振波谱（MRS）在星形细胞肿瘤术前分级中的价值。方法52例患者均经病理证实，其中弥漫性星形细胞瘤（WHO2级）20例。间变性星形细胞瘤（WHO3级）14例，胶质母细胞瘤（WHO4级）18例。MRS采用多体素PRESS序列。结果①星形细胞肿瘤在MRS上常表现为Cho升高、NAA降低，级别越高变化越明显。在高度恶性星形细胞肿瘤中还可出现Lip峰。②对病例组中32例高度恶性星形细胞肿瘤采用Pearson相关回归分析法显示，肿瘤实质区的Cho／Cr（r=0．656，P=0．000）、Lip1．3／Cr（r=0．559．P=0．001）及Glx／Cr（r=0．482，P=0．005）均与肿瘤的病理分级呈显著正相关；Cho／NAA（r=0．395，P=0．025）、Lip0．9／Cr（r=0．386，P=0．029）与病理分级呈正相关。③当Cho／Cr=2时．诊断WHO4级星形细胞肿瘤的敏感性为94．4％，特异性为64．3％，阳性预测值为77．3％，阴性预测值为90％。④当Lip1．3／Or=0．526时，诊断为WHO4级星形细胞肿瘤的敏感性为88．9％，特异性为92．9％．阳性预测值为94．1％，阴性预测值为86．7％。结论MRS是一种有潜力的方法，有助于对肿瘤术前进行分级。Objective To explore the value of MR spectroscopy in preoperative grading of astrocytic tumors. Methods 52 cases with astrocytomas proved by pathology,including 20 diffuse astrocytomas, 14 anaplastic astrocytomas and 18 glioblastomas, underwent MR spectroscopy with multi--voxel PRESS sequence. Results （1）Astrocytic tumors were characterized by increased Cho and decreased NAA, while Lipids were present in high-- grade astroeytic tumors ; （2）Cho/Cr （ r= 0.656, P = 0. 000 ）, Lipl. 3/Cr（ r= 0.559, P = 0. 001） and Glx/Cr（ r= 0. 482, P= 0. 005） in the solitary tumor＇s regions had a significant positive correlation with the grading of astrocytie tumors, while Cho/NAA（r=0. 395,P=0. 025）,Lip0.9/Cr（r=0. 386,P=0. 0291 had a positive correlation with the tmor grading;（3）When Cho/Cr = 2, the sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 94.4% ,64.3% ,77.3% and 90% respectively;（4）When Lip1. 3/Cr=0. 526, the sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 88.9 %, 92.9 %, 94.1% and 86.7% respectively. Conclusion MR spectroscopy is helpful in preoperative grading of astrocytic tumors.

关 键 词：脑 星形细胞肿瘤 磁共振成像 磁共振波谱 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]