^1H-MRS对颅内高级别胶质瘤与感染性肉芽肿的鉴别诊断价值  

Diagnostic value of 1H-MRS for discriminating intracranial high-grade gliomas and infectious granulomas

作　　者：李辉 付丽媛 钟群 肖慧 许尚文 陈自谦 LI Hui;FU Li-yuan;ZHONG Qun;XIAO Hui;XU Shang-wen;CHEN Zi-qian(Radiology Department,the 900th Hospital of Joint Logistics Support Force,Fuzhou 350025,China;The Affilicated Dongfang Hospital of Xiamen University,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第900医院放射诊断科,福州350025 [2]厦门大学附属东方医院,福州350025

出　　处：《医疗卫生装备》2020年第8期6-9,31,共5页Chinese Medical Equipment Journal

基　　金：福建省自然科学基金项目(2018J01344);全军青年培育项目(2018J01344)。

摘　　要：目的:探讨氢质子磁共振波谱(1H-magnetic resonance spectroscopy,1H-MRS)技术在颅内高级别胶质瘤(high grade gliomas,HGGs)与感染性肉芽肿鉴别诊断中的价值,以评价该技术对2种疾病诊断的准确性。方法:回顾性分析某院2011-2018年38例拟诊为颅内HGGs和感染性肉芽肿患者的影像资料,所有患者均有明确的手术病理结果或有明确的临床诊断,其中HGGs 22例(HGGs组)、感染性肉芽肿16例(感染性肉芽肿组)。所有患者术前或治疗前均行MRI常规序列(增强)及1H-MRS扫描。1H-MRS扫描结束后数据自动传送至Siemens Syngo B19后处理工作站进行规范化后处理,检测2组病灶区及对侧脑区的乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)及脂质(Lip)峰的峰值,并计算病灶中Cho和NAA、Cho和Cr的峰值比(Cho/NAA和Cho/Cr)及Cho、NAA、Cr、Lac+Lip病灶和健侧的峰值比[Cho病灶/Cho健侧、NAA病灶/NAA健侧、Cr病灶/Cr健侧及(Lac+Lip)病灶/(Lac+Lip)健侧]。选用方差分析或者Wilcoxon符号秩检验对比2组1H-MRS各代谢物峰值或其比值的差异。将2组数据进行ROC曲线绘制,计算AUC值。结果:颅内感染性肉芽肿1H-MRS多表现病灶Cho峰升高,NAA峰略降低。HGGs 1H-MRS多表现病灶Cho峰升高,NAA峰降低。Cho/NAA、Cho/Cr及Cho病灶/Cho健侧值在2组间存在显著差异(P<0.05),Cho/NAA对区分2种疾病的敏感度为82.2%、特异度为88.4%。结论:1H-MRS对颅内HGGs和感染性肉芽肿具有较好的诊断鉴别价值,其中Cho/NAA值对区分2种疾病具有较高的敏感度和特异度。Objective To evaluate the value of^1H-MRS for discriminating intracranial high grade gliomas(HGGs)and infectious granulomas to evaluate the accuracies of the technology when used to diagnose the two diseases.Methods The imaging data of 38 patients proposed to be diagnosed with intracranial HGGs and infected granulomas from 2011-2018 in a certain hospital were retrospectively analyzed,and all the patients had clear surgical pathological findings or a clear clinical diagnosis,including 22 patients with HGGs(HGGs group)and 16 patients with infected granulomas(infected granuloma group).All the patients underwent MRI routine sequence(enhancement)and^1H-MRS scan before surgery or treatment.After^1H-MRS scan,the data were automatically transferred to Siemens Syngo B19 post-processing workstation for standardized post-processing to detect the peak values of acetylaspartate(NAA),choline(Cho),creatine(Cr),lactate(Lac)and lipid(Lip)in the focal area and contralateral brain area of the 2 groups,and the ratios of the peak value of Cho to that of NAA(Cho/NAA)and to that of Cr(Cho/Cr)were calculate in the foci.The ratios of the peak values of Cho,NAA,Cr and Lac+Lip in the foci to those in the intact side(Chof/Choi,NAAf/NAAi,Crf/Cri and(Lac+Lip)f/(Lac+Lip)i)were computed respectively.ANOVA or Wilcoxon signed-rank test was chosen for analyzing the differences between the 2 groups of^1H-MRS for each metabolite peak or its ratio.ROC curves were plotted for the 2 groups and AUC values were calculated.Results^1H-MRS showed the infectious granulomas patients had the peak values of Cho increased while those of NAA decreased insignificantly in the focal area,and the HGGs patients was found to have the peak values of Cho raised significantly while those of NAA lowered obviously in the focal area.There were statistical differences between the two groups in Cho/NAA,Cho/Cr and Chof/Choi(P<0.05).Cho/NAA ratio had the sensitivity being 82.2%and the specialty being 88.4%when used to discriminate intracranial HGGs and infectious granulomas.Conc

关 键 词：MRI 1H-MRS 颅内 高级别胶质瘤 感染性肉芽肿 ROC曲线 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学] R742.9[医药卫生—临床医学]