表观扩散系数值联合磁共振波谱成像在原发性中枢神经系统淋巴瘤诊断中的应用:基于Logistic回归模型  

Application of apparent diffusion coefficient value combined with magnetic resonance spectroscopy in diagnosis and differentiation of primary central nervous system lymphoma evaluating by Logistic regression model

作　　者：耿磊 孙毅 赵妍 万金鑫 许磊 叶永盛 陆格 汪秀玲 徐凯 GENG Lei;SUN Yi;ZHAO Yan;WAN Jinxin;XU Lei;YE Yongsheng;LU Ge;WANG Xiuling;XU Kai(Department of Medical Imaging,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;Department of Medical Imaging,the People's Hospital of Khorgas,Ili 835221,China;Department of Medical Imaging,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]蚌埠医学院附属连云港市第二人民医院(江苏大学附属连云港医院//连云港市肿瘤医院)医学影像科,江苏连云港222000 [2]霍尔果斯市人民医院医学影像科,新疆伊犁835221 [3]徐州医科大学附属医院医学影像科,江苏徐州221002

出　　处：《分子影像学杂志》2021年第4期594-601,共8页Journal of Molecular Imaging

基　　金：蚌埠医学院科技发展基金项目(BYKY18188);江苏大学临床医学科技发展基金资助(JLY20180158);连云港市第二人民医院中青年人才成长基金科研课题计划(TQ201906),江苏省卫生健康委2020年度医学科研项目(Z2020144)。

摘　　要：目的在Logistic回归模型下探讨肿瘤不同区域表观扩散系数(ADC)值联合磁共振波谱成像(MRS)代谢产物的相对比值在原发性中枢神经系统淋巴瘤(PCNSL)诊断与鉴别中的应用价值。方法分析及检测经临床及病理证实32例PCNSL和40例高级别胶质瘤(HGG)常规MRI及扩散加权成像、MRS特征,分别测量肿瘤实质区、近侧瘤周(瘤周1 cm以内的水肿区)、远侧瘤周(瘤周1 cm以外水肿区)及对侧正常脑白质的ADC值,并计算平均值。采用二维多体素1H MRS成像,测量并计算代谢产物相对比值。统计学分析两组肿瘤不同区域ADC值及MRS代谢产物的相对比值的差异,采用二元logistic回归筛选对PCNSL和HGG鉴别价值较高的指标,进行logistic回归分析,并使用ROC曲线分析比较各指标单独诊断及联合诊断对两组肿瘤的诊断效能。结果PCNSL组与HGG组肿瘤实质、近侧瘤周、远侧瘤周、对侧脑白质的ADC值组内比较总体差异有统计学意义(P<0.001),两两比较差异有统计学意义(P<0.05)。PCNSL组与HGG组不同区域ADC值变化趋势分别为:先升后降抛物线型、折线上升型。单独诊断对两者鉴别时,肿瘤实质ADC值对两者的诊断效能最高(曲线下面积=0.880)。PCNSL组与HGG不同区域胆碱复合物(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、脂质(Lip)/Cr值进行组内比较,总体差异有统计学意义(P<0.001)。组内两两比较:PCNSL组与HGG组肿瘤实质Cho/Cr、Cho/NAA、Lip/Cr值均大于近侧瘤周、远侧瘤周、对侧脑白质;Lip/Cr在两者肿瘤实质的组间比较中具有显著的统计学意义(t=6.418,P<0.001)。Logistic回归方程模型为:Logistic(P)=-13.190+1.374×近侧瘤周ADC值+0.542×肿瘤实质Lip/Cr值,高水平的近侧瘤周ADC值和肿瘤实质Lip/Cr值是倾向PCNSL的危险因素。在Logistic回归方程模型下,联合诊断曲线下面积最大(曲线下面积=0.973),鉴别诊断两组的敏感度、特异性分别为:90.6%、97.5%(P<0.001),联合诊�Objective To investigate the application value of the apparent diffusion coefficient(ADC)value of different tumor regions combined with the relative ratio of MRS metabolites in the diagnosis and differentiation of primary central nervous system lymphoma(PCNSL)under Logistic regression model.Methods The characteristics of conventional MRI,DWI and MRS in 32 cases of PCNSL and 40 cases of HGG confirmed by clinical and pathology were analyzed and detected.The ADC values of tumor parenchyma,proximal peritumor(edema area within 1cm around the tumor),distal peritumor(edema area beyond 1cm around the tumor)and contralateral normal white matter were measured.The average values were calculated.Two-dimensional multi-voxel 1H MRS imaging was used to measure and calculate the relative ratio of metabolites.The differences of ADC values and the relative ratio of MRS metabolites in different regions of the two groups were analyzed.The indicators with higher differential value of PCNSL and HGG were screened by binary logistic regression analysis,and the diagnostic efficacy of each indicator alone and combined in the diagnosis of tumors in the two groups was compared by ROC curve analysis.Results The overall differences in ADC values of tumor parenchyma,proximal peritumor,distal peritumor and contralateral white matter between PCNSL group and HGG group were significant within the group(all P<0.001),and the pair comparison was statistically rising significant(all P<0.05).The variation trend of ADC values in different areas of PCNSL group and HGG group were as follows:first and then falling parabola type and breaking line rising type,respectively.The ADC value of tumor parenchyma had the highest diagnostic efficacy(AUC=0.880)for the differentiation of tumor parenchyma and tumor parenchyma.Choline complex(Cho)/creatine(Cr),Cho/N-acetyl aspartic acid(NAA)and lipid(Lip)/Cr values in different regions of HGG group and PCNSL group were compared within the group(P<0.001).Pair comparison within groups:the values of Cho/Cr,Cho/NAA and Lip/C

关 键 词：淋巴瘤 胶质瘤 磁共振波普 表观扩散系数 近侧及远侧瘤周水肿 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.4[医药卫生—诊断学]