多模态影像技术在胶质瘤复发与放射性坏死鉴别诊断中的价值  

Application value of multimodal imaging in differential diagnosis of glioma recurrence from radiation necrosis

作　　者：张诚[1] 麦麦提依明·托合提 王继超[1] 杨小朋[1] 吴永刚[1] ZHANG Cheng;MAIMAITIYIMING Tuoti;WANG Ji-chao;YANG Xiao-peng;WU Yong-gang(Department of Neurosurgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院神经外科,乌鲁木齐183000

出　　处：《中国临床神经外科杂志》2022年第10期812-815,818,共5页Chinese Journal of Clinical Neurosurgery

基　　金：新疆维吾尔自治区自然科学基金(2019D01C107)。

摘　　要：目的探讨多模态影像技术在脑胶质瘤复发和放射性坏死鉴别诊断中的应用价值。方法回顾性分析2016年6月至2021年12月手术治疗并经术后病理检查确诊的45例胶质瘤的临床资料。以二次手术或穿刺活检病理检查结果作为诊断胶质瘤复发和放射性坏死的金标准。术后3~6个月,灌注加权成像(PWI)检测相对脑血容量(rCBV),弥散成像(DWI)检测表观弥散系数(ADC),磁共振波谱(MRS)检测N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)等参数并计算Cho/NAA、Cho/Cr比值,PET-CT检测标准摄取值(SUV)。结果45例中,胶质瘤复发34例(复发组),放射性坏死11例(坏死组)。复发组rCBV、SUV、Cho/NAA值明显大于坏死组(P<0.05),而ADC值明显小于坏死组(P<0.05);两组Cho/Cr值无统计学差异(P>0.05)。ROC曲线分析显示,rCBV、ADC、Cho/NAA、Cho/Cr、SUV均具有鉴别价值,其中rCBV效果最佳(P<0.05);而Cho/Cr无明显鉴别意义(P>0.05)。rCBV、ADC、Cho/NAA、Cho/Cr、SUV联合鉴别的敏感度、特异度分别为99%和100%,明显优于单一指标(P<0.01)。结论单纯应用MRI或PET-CT某一序列或单一检查手段鉴别胶质瘤复发与放射性坏死具有一定局限性,联合应用PWI、DWI、MRS、PET-CT,可显著提高鉴别诊断准确率,对制定个体化治疗方案具有重要临床意义。Objective To explore the application value of multimodal imaging in the differential diagnosis of glioma recurrence from radiation necrosis.Methods The clinical data of 45 patients with glioma who underwent microsurgery from June 2016 to December 2021 were retrospectively analyzed.The gold standard for the diagnosis of glioma recurrence and radiation necrosis was the pathological examination after second operation or biopsy.Within 3 to 6 months after operation,the relative cerebral blood volume(rCBV)was detected by perfusion weighted imaging(PWI);the apparent diffusion coefficient(ADC)was detected by diffusion imaging(DWI);the parameters of N-acetylaspartate(NAA),choline(Cho)and creatine(Cr)were detected by magnetic resonance spectroscopy(MRS)and the ratio of Cho/NAA and Cho/Cr was calculated;the standard uptake value(SUV)was detected by PET-CT.Results Of these 45 patients,34 patients were glioma recurrence(recurrence group),and 11 radiation necrosis(necrosis group).The values of rCBV,SUV and Cho/NAA in the recurrence group were significantly higher than those in the necrosis group(P<0.05),while the ADC values in the recurrence group were significantly lower than those in the necrosis group(P<0.05).There was no significant difference in Cho/Cr between both groups(P>0.05).ROC curve analysis showed that rCBV,ADC,Cho/NAA,Cho/Cr and SUV had differential value,and rCBV was the best(P<0.05).However,Cho/Cr had no significant difference(P>0.05).The sensitivity and specificity of rCBV,ADC,Cho/NAA,Cho/Cr combined with SUV were significantly better than that of single imaging parameter(P<0.01),with a sensitivity and specificity of 99%and 100%,respectively.Conclusions MRI or PET-CT alone has certain limitations in differentiating glioma recurrence from radiation necrosis.Combined application of PWI,DWI,MRS and PET-CT can significantly improve the accuracy of differential diagnosis,which has important clinical significance for making individualized treatment plan.

关 键 词：胶质瘤 术后复发 放射性坏死 鉴别诊断 多模态影像 

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