多模态磁共振技术在胶质瘤复发与放射性脑损伤鉴别诊断中的应用价值  

The value of multimodal magnetic resonance imaging in the differential diagnosis of glioma recurrence and radiation brain injury

作　　者：葛光治[1] 杨艺[1] 张强[1] 

机构地区：[1]北京军区总医院附属八一脑科医院神经影像科,北京100700

出　　处：《解放军医学杂志》2015年第11期921-926,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨联合应用弥散加权成像(DWI)、灌注加权成像(PWI)、磁共振波谱成像(MRS)等磁共振成像技术对胶质瘤复发与放射性脑损伤的鉴别诊断价值。方法回顾性分析2011年1月-2013年12月32例在北京军区总医院就诊的胶质瘤术后放疗患者的临床及影像学资料,其中胶质瘤复发15例,放射性脑损伤17例。分析32例患者的DWI、PWI、MRS等磁共振影像学资料,比较异常强化区与对侧正常区的磁共振表观扩散系数(ADC)、自动生成脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、胆碱(Cho)/磷酸肌酸(Cr)比值及Cho/N-乙酰天门冬氨酸(NAA)比值。结果胶质瘤复发组ADC值与放射性脑损伤组比较差异无统计学意义(P>0.05)。胶质瘤复发组相对脑血流量(r CBF)、相对脑血容量(r CBV)的最大值和平均值明显高于放射性脑损伤组(P<0.05),相对平均通过时间(r MTT)的最大值和平均值与放射性脑损伤组比较差异无统计学意义(P>0.05)。胶质瘤复发组的Cho/Cr和Cho/NAA比值均明显高于放射性脑损伤组(P<0.05)。对胶质瘤复发的诊断灵敏度,单用PWI为80%,单用MRS为73.3%,PWI联合MRS为93.3%。对放射性脑损伤的诊断灵敏度,单用PWI为82.4%,单用MRS为70.6%,PWI联合MRS为88.2%。结论联合应用多模态磁共振成像技术可提高胶质瘤复发及放射性脑损伤的诊断准确性,为临床治疗提供良好的指导。Objective To explore the application of a combination of diffusion weighted imaging（DWI）, perfusion weighted imaging（PWI） and magnetic resonance spectroscopy（MRS） in the differential diagnosis of glioma recurrence and radiation brain injury. Methods The clinical and imaging data of 32 patients were retrospectively analyzed, including 15 cases of glioma recurrence and 17 cases of radiation brain injury, admitted from Jan. 2011 to Dec. 2013 in General Hospital of Beijing Command. The DWI, PWI and MRS data of the 32 patients were retrospectively analyzed. The following values were compared between abnormal enhancement area and contralateral normal area： magnetic resonance apparent diffusion coefficient（ADC）, relative cerebral blood flow（r CBF）, relative cerebral blood volume（r CBV）, relative mean transit time（r MTT）, choline/creatine（Cho/Cr） and choline/N-acetyl aspartate（Cho/NAA） ratio. Results No statistical significance of ADC and r MTT values was found between glioma recurrence group and radiation brain injury group（P0.05）; The maximum and average r CBF and r CBV values were significantly higher in glioma recurrence group than in radiation brain injury group（P0.05）, but no statistical difference was found between the two groups on maximum and average r MTT value（P0.05）. The ratios of Cho/Cr and Cho/NAA were higher in glioma recurrence group than in radiation brain injury group（P0.05）. The diagnostic sensitivity of PWI to glioma recurrence was 80.0%, of MRS was 73.3%, and of PWI combined with MRS was 93.3%. The diagnostic sensitivity of PWI to radiation brain injury was 82.4%, of MRS was 70.6%, and of PWI combined with MRS was 88.2%. Conclusion Combined application of multimodal magnetic resonance imaging technology may improve the diagnostic accuracy to glioma recurrence and radiation brain injury, thus provide a good guidance for clinical treatment.

关 键 词：神经胶质瘤 肿瘤复发 局部 脑损伤 放射性 弥散加权成像 灌注加权成像 磁共振波谱成像 

分 类 号：R739.41[医药卫生—肿瘤]