磁共振波谱成像联合弥散加权成像检查对胶质瘤术前分级的诊断价值及对术后复发的预测价值  

Value of magnetic resonance spectroscopy combined with diffusion weighted imaging in diagnosing preoperative grading and predicting postoperative recurrence of glioma

作　　者：张军晖[1] 孙峻峰[2] 刘亚萍 ZHANG Junhui;SUN Junfeng;LIU Yaping(Department of Medical Imaging,Baoji People’s Hospital,Baoji 721000,Shaanxi,China;Department of Neurosurgery,Baoji People’s Hospital,Baoji 721000,Shaanxi,China;Department of Medical Imaging,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,Shaanxi,China)

机构地区：[1]宝鸡市人民医院医学影像科,陕西宝鸡721000 [2]宝鸡市人民医院神经外科,陕西宝鸡721000 [3]西安交通大学第一附属医院影像科,西安7100610

出　　处：《癌症进展》2023年第24期2760-2763,2779,共5页Oncology Progress

基　　金：陕西省重点研发计划项目(S2017-ZDYF-YBXM-SF-0541)。

摘　　要：目的分析磁共振波谱成像(MRS)联合弥散加权成像(DWI)检查对胶质瘤术前分级的诊断价值及对术后复发的预测价值。方法选取121例胶质瘤患者,其中低级别54例,高级别67例。所有患者均行MRS、DWI检查,且术后6个月进行复查,根据复发情况分为复发组43例与非复发组78例。比较术前不同分级胶质瘤患者及不同复发情况胶质瘤患者的MRS、DWI参数;以病理结果为金标准,分析MRS、DWI单独及联合检查对术前分级的诊断效能及对术后复发的预测效能。结果高级别组患者表观弥散系数(ADC)、相对表观弥散系数(rADC)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)、NAA/肌酸(NAA/Cr)均明显低于低级别组,Cho/Cr明显高于低级别组,差异均有统计学意义(P﹤0.01)。MRS、DWI单独及联合检查诊断胶质瘤术前分级与病理结果的一致性Kappa值分别为0.533、0.507及0.752。MRS、DWI联合检查诊断胶质瘤术前分级的灵敏度(92.59%)、特异度(91.04%)、准确度(91.74%)均高于MRS、DWI单独检查。复发组患者ADC、rADC、NAA/Cho及NAA/Cr均明显低于非复发组,Cho/Cr明显高于非复发组,差异均有统计学意义(P﹤0.01)。MRS、DWI联合检查预测胶质瘤术后复发的灵敏度、特异度、曲线下面积(AUC)分别为88.37%、91.52%、0.830(95%CI:0.687~0.912),均高于MRS、DWI单独检查。结论MRS、DWI参数对于胶质瘤术前分级、术后复发具有一定诊断和预测价值,且MRS、DWI联合检查可提升对胶质瘤术前分级的诊断价值和对术后复发的预测价值,可为临床相关诊治方案的制订提供参考信息。Objective To analyze the value of magnetic resonance spectroscopy(MRS)combined with diffusion weighted imaging(DWI)in diagnosing preoperative grading and predicting postoperative recurrence of glioma.Method A total of 121 patients with glioma including 54 cases of low grade and 67 cases of high grade were selected.All patients underwent MRS and DWI examination,and were re-examined 6 months after the completion of surgery.The patients were divided into the recurrence group of 43 cases and non-recurrence group of 78 cases.The MRS and DWI parameters of preoperative patients with glioma of different grade and the patients with different recurrence status were compared.The diagnostic performance of single and combined examination of MRS and DWI for preoperative grading and predictive performance for postoperative recurrence were analyzed using pathological results as the gold standard.Result The apparent diffusion coefficient(ADC),relative apparent diffusion coefficient(rADC),N-acetyl aspartate/choline(NAA/Cho)and NAA/creatine(NAA/Cr)of the high-grade group were significantly lower than those of the low-grade group,and the Cho/Cr was higher than that of the low-grade group(P<0.01).The Kappa values of consistency for single and combined examination of MRS and DWI in diagnosing preoperative grading with pathological diagnosis were 0.533,0.507 and 0.752 respectively;the sensitivity(92.59%),specificity(91.04%)and accuracy(91.74%)of combined examination of MRS and DWI in diagnosing preoperative grading of glioma were higher than the single examination.The ADC,rADC,NAA/Cho and NAA/Cr in the recurrence group were significantly lower than those in the non-recurrence group,and the Cho/Cr was higher than that in the non-recurrence group(P<0.01).The sensitivity,specificity,and area under the curve(AUC)of combined examination of MRS and DWI in predicting postoperative recurrence were 88.37%,91.52%,0.830(95%CI:0.687-0.912),respectively,which were higher than the single examination of MRS and DWI.Conclusion MRS and DWI parameters h

关 键 词：磁共振波谱成像 弥散加权成像 胶质瘤 术前分级 术后复发 

分 类 号：R739.41[医药卫生—肿瘤]