^(1)H-MRS和3D-ASL技术在脑胶质瘤术后复发与放射性坏死鉴别中的应用价值探索  

Differentiation Between Radiation Necrosis and Glioma Recurrence Using^(1)H-MRS and 3D-ASL

作　　者：周克阳 蔡强 邓灵灵 代月黎 彭建春 陈志华 ZHOU Keyang;CAI Qiang;DENG Lingling(Department of Imaging and Radio Diagnosis,the Second Affiliated Hospital,Hengyang Medical School,University of South China,Hengyang,Hunan Province 421001,P.R.China)

机构地区：[1]南华大学衡阳医学院附属第二医院放射影像科,衡阳421001 [2]湖南省脑科医院放射科(湖南省第二人民医院),长沙410007

出　　处：《临床放射学杂志》2024年第7期1060-1066,共7页Journal of Clinical Radiology

基　　金：湖南省卫生健康委科研项目(编号:202109011222);衡阳市科技局指导性项目(编号:2019jh010987)。

摘　　要：目的探讨磁共振氢质子波谱成像(^(1)H-MRS)与三维动脉自旋标记(3D-ASL)成像技术在脑胶质瘤术后复发与放射性脑坏死鉴别诊断中的应用价值。方法回顾分析40例脑胶质瘤术后放疗患者,分为术后复发(TR)组23例,放射性脑坏死(RN)组17例。所有被试均接受MRI平扫+增强、DWI、^(1)H-MRS及3D-ASL检查,并通过后处理软件获取感兴趣区(ROI)内代谢物比值[N-乙酰天门冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、胆碱/N-乙酰天门冬氨酸(Cho/NAA)]与脑血流量(CBF)值。采用SPSS软件对人口学资料、临床资料和影像学指标进行统计分析,并计算^(1)H-MRS指标与3D-ASL指标之间的Pearson相关性。最后,基于ROC曲线分析对^(1)H-MRS、3D-ASL及两者联合的诊断效能进行评估。结果与同层面正常的脑组织比较,TR组ROI的Cho/Cr(2.527±0.565)、Cho/NAA(3.074±1.407)、CBF值[(76.666±15.961)ml·min^(-1)·100g^(-1)]显著增加;RN组ROI的Cho/Cr(1.275±0.266)、Cho/NAA(1.280±0.389)、CBF值[(33.359±8.283)ml·min^(-1)·100g^(-1)]显著降低,且TR组上述指标均显著高于RN组(P<0.05);而TR组ROI的NAA/Cr值(0.871±0.344)低于RN组(1.107±0.272)(P值为0.025);相关性分析发现所有研究被试ROI的CBF值与Cho/Cr、Cho/NAA均存在显著正相关(r值分别为0.864、0.624,P值均<0.001)。此外,ROC曲线分析发现^(1)H-MRS指标、3D-ASL指标及两者联合在TR与RN鉴别诊断中的敏感度均为100%,特异度分别为87.00%、91.30%、95.70%,AUC值分别为0.985、0.989、0.986。结论^(1)H-MRS及3D-ASL指标对TR与RN鉴别诊断均具有很好的敏感度,联合使用可以提高TR与RN鉴别诊断的特异度,这提示^(1)H-MRS和3D-ASL技术在胶质瘤术后的评估中具有重要价值。Objective This study was aimed to investigate the application value of proton magnetic resonance spectroscopy(^(1)H-MRS)and 3D arterial spin labeling(3D-ASL)for the differential diagnosis of radiation induced brain injury from glioma recurrence in glioma patients.Methods A retrospective analysis was performed by 40 glioma patients who underwent MRI plain scan+enhanced scan,DWI,and^(1)H-MRS and 3D-ASL examinations.The included patients were classified into a glioma recurrence(TR)group(n=23)and a radiation necrosis(RN)group(n=17)based on subsequent pathologic analysis or clinical-radiological follow-up.The metabolite ratios(NAA/Cr,Cho/Cr,Cho/NAA)and cerebral blood flow(CBF)value in the region of interest(ROI)of lesions were measured and compared between the two groups.Moreover,demographic data,clinical data,and imaging parameters were statistically and the Pearson correlations analysis between^(1)H-MRS and 3D-ASL measures was performed with SPSS software.Finally,the diagnostic efficacy of^(1)H-MRS,3D-ASL,and the combination of these two techniques was evaluated based on the receiver operating characteristic(ROC)curve analysis.Results In compare to contralateral normal brain tissue,TR group's lesion show increased Cho/Cr(2.527±0.565),Cho/NAA(3.074±1.407),and CBF[(76.666±15.961)ml·min^(-1)·100g^(-1)],while those measures Cho/Cr(1.275±0.266),Cho/NAA(1.280±0.389),and CBF[(33.359±8.283)ml·min^(-1)·100g^(-1)]exhibited decreasing trend in the RN group.Compared to the RN group,obvious measures were significantly higher in the TR group(P<0.005),but the NAA/Cr(1.107±0.272)ratio was significantly decreased in the TR group(0.871±0.344)(P=0.025).Furthermore,a positively correlation was find between the CBF values and Cho/Cr and Cho/NAA(r=0.864 and 0.624,with P=0.001,respectively)in all subjects.ROC curve analysis suggested 100% sensitivity for^(1)H-MRS,3D-ASL,and^(1)H-MRS combined with 3D-ASL indicators in the differential diagnosis of TR and RN,obtaining the specificity of 87.00%,91.30%,and 95.70% along with AUC va

关 键 词：脑胶质瘤 磁共振氢质子波谱成像 动脉自旋标记 术后复发 放射性坏死 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]