动脉自旋标记联合MR波谱对高级别脑胶质瘤患者术后复发与假性进展的鉴别价值  

Differential value of arterial spin labeling combined with MR spectroscopy for postoperative recurrence and pseudoprogression in patients with high-grade glioma

作　　者：韩静波 贺苗 王新文[4] HAN Jingbo;HE Miao;WANG Xinwen(Shanxi Medical University,Taiyuan 030001,China;Department of Imaging,Heji Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi Province 046000,China;Department of Medical Oncology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi Province 046000,China;Department of Radiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]长治医学院附属和济医院影像科,山西长治046000 [3]长治医学院附属和平医院肿瘤内科,山西长治046000 [4]山西医科大学第二医院放射科,山西太原030001

出　　处：《实用放射学杂志》2024年第10期1582-1586,共5页Journal of Practical Radiology

摘　　要：目的探讨动脉自旋标记(ASL)联合磁共振波谱(MRS)对高级别脑胶质瘤患者术后复发与假性进展的鉴别价值。方法选取102例行高级别脑胶质瘤手术且放疗结束后出现新发或扩大的强化灶患者,根据病理检查结果分为复发组(63例)和假性进展组(39例)。比较2组患者病灶局部代谢产物及其比值情况和病灶局部血流情况,分析ASL和MRS对高级别脑胶质瘤患者术后复发与假性进展的鉴别价值。结果复发组胆碱(Cho)/肌酸(Cr)值、Cho/N-乙酰天门冬氨酸(NAA)值和病变区相对脑血流量(rCBF)显著高于假性进展组(P<0.05);MRS、ASL、ASL+MRS与实际预后比较的Kappa值分别为0.344、0.448、0.712(P<0.05)。MRS检查结果敏感度为66.67%,特异度为69.23%,准确率为67.65%;ASL检查结果敏感度为76.19%,特异度为69.23%,准确率为73.53%;联合检查采用并联,结果敏感度为88.89%,特异度为69.23%,准确率为81.37%;Cho/Cr值、Cho/NAA值、病变区rCBF和联合检测的受试者工作特征(ROC)曲线的曲线下面积(AUC)分别为0.657、0.844、0.831、0.922。联合检测AUC明显高于各指标单独检测,差异有统计学意义(Z=5.028、2.063、2.242,P<0.05)。结论ASL联合MRS对高级别脑胶质瘤患者术后复发与假性进展的鉴别能力优于二者单独检测。Objective To explore the differential value of arterial spin labeling(ASL)combined with magnetic resonance spectroscopy(MRS)for postoperative recurrence and pseudoprogression in patients with high-grade glioma.Methods A total of 102 patients with high-grade glioma and new or expanded enhancement lesions after radiotherapy were enrolled.According to the results of pathological examination,they were divided into recurrence group(63 cases)and pseudoprogression group(39 cases).The local metabolites of lesions and their ratios,and local blood flow of lesions were compared between the two groups.The differential value of ASL and MRS for postoperative recurrence and pseudoprogression in patients with high-grade glioma was analyzed.Results Choline(Cho)/creatine(Cr)value,Cho/N-acetylaspartate(NAA)value and relative cerebral blood flow(rCBF)of lesion area in the recurrence group were significantly higher than those in the pseudoprogression group(P<0.05).Compared with actual prognosis,Kappa values of MRS,ASL and ASL+MRS were 0.344,0.448 and 0.712,respectively(P<0.05).The sensitivity,specificity and accuracy of MRS,ASL and ASL+MRS(parallel mode)were(66.67%,69.23%,67.65%),(76.19%,69.23%,73.53%)and(88.89%,69.23%,81.37%),respectively.The area under the curve(AUC)of receiver operating characteristic(ROC)curve of Cho/Cr value,Cho/NAA value,rCBF of lesion area and combined detection were 0.657,0.844,0.831 and 0.922,respectively.The AUC of combined detection was significantly higher than that of single index(Z=5.028,2.063,2.242,P<0.05).Conclusion Compared with single detection,the differential ability of ASL combined with MRS is higher for postoperative recurrence and pseudoprogression in patients with highgrade glioma.

关 键 词：动脉自旋标记 磁共振波谱 高级别脑胶质瘤 

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]