磁共振增强扫描无强化的不同级别脑胶质瘤临床特征的对比分析  

Comparative analysis of clinical characteristics between high-and low-grade non-enhancing gliomas basedonMRI

作　　者：曾令成[1] 厉华 陈如东 杨洪宽 陈坚[1] 于加省 Zeng Lingcheng;Li Hua;Chen Rudong;Yang Hongkuan;Chen Jian;Yu Jiasheng(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2024年第11期1125-1130,共6页Chinese Journal of Neurosurgery

摘　　要：目的通过与磁共振增强扫描无强化的低级别脑胶质瘤患者进行对比, 探讨磁共振增强扫描无强化的高级别脑胶质瘤的临床特征。方法回顾性分析2021年1月至2023年12月华中科技大学同济医学院附属同济医院神经外科收治的磁共振增强扫描无强化、接受手术治疗且病理学诊断明确的成人(年龄≥18岁)脑胶质瘤患者的临床资料。通过单因素分析对比高级别组[世界卫生组织(WHO)3、4级]与低级别组(WHO 2级)的临床特征, 并将其中差异具有统计学意义(P<0.05)的因素纳入多因素logistic回归模型分析, 寻找与高级别相关联的特征。结果共纳入126例患者, 其中高级别组46例(36.5%), 包括38例WHO 3级和8例WHO 4级患者;低级别组80例(63.5%)。单因素分析结果表明, 两组患者的年龄、肿瘤生长速率、相对表观弥散系数、胆碱/肌酸及胆碱/N-乙酰天冬氨酸值、危险程度的差异均有统计学意义(均P<0.05), 而性别、有无癫痫发作、肿瘤的最大径或部位、有无瘤周水肿、T2-液体衰减反转恢复序列错配征、肿瘤病理学类型的差异均无统计学意义(均P>0.05)。多因素logistic回归模型分析显示, 患者的年龄>40岁(OR=3.55, 95%CI:1.30~11.48)、肿瘤生长速率>8 mm/年(OR=17.30, 95%CI:7.89~41.94)、较低的相对表观弥散系数(OR=0.77, 95%CI:0.56~0.97)、较高的胆碱/肌酸比值(OR=1.14, 95%CI:1.08~1.20)和胆碱/N-乙酰天冬氨酸比值(OR=3.73, 95%CI:1.50~9.35)与肿瘤呈高级别有关(均P<0.05)。结论对于年龄>40岁和(或)肿瘤生长速率>8 mm/年的磁共振增强无强化的脑胶质瘤患者, 术前需高度警惕其病变为高级别的可能;进一步配合功能磁共振弥散加权成像和(或)磁共振波谱检查有助于术前对肿瘤级别的判断。Objective To investigate the clinical characteristics indicating high-grade non-enhancing gliomas based on MRI by comparing with those of patients with non-enhancing low-grade gliomas.Methods The clinical data of adult patients with non-enhancing hemispheric gliomas based on MRI who were surgically treated and pathologically diagnosed from January 2021 to December 2023 in the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively reviewed.The clinical characteristics between the high-grade(WHO grade 3 and 4)and low-grade(WHO grade 2)patients were compared using univariate analysis.The indicators with P<0.05 were further included in the multivariate logistic regression model to explore the characteristics indicating high-grade tumorR.IesultsA total of 126 MRI non-enhancing glioma patients were included,of which 46 cases(36.5%)were in the high grade group(including 38 WHO grade 3 cases and 8 WHO grade 4 cases)and 80 cases(63.5%)were in the low-grade group.Univariate analysis showed that age,tumor growth rate,relative apparent diffusion coefficient,choline(Cho)/creatine(Cr)ratio and Cho/N-acetylaspartate(NAA)ratio were significant risk factors between groups(all P<0.05),while sex,seizure,tumor size or site,T2-fluid attenuated inversion recovery mismatch sign,tumor pathology were not significant(all P>0.05).Multivariate analysis showed that age>40 years(OR=3.55,95%CI:1.30-11.48),tumor growth rate>8 mm/year(OR=17.30,95%CI:7.89-41.94),lower relative apparent diffusion coefficient(OR=0.77,95%CI:0.56-0.97)in MR diffusion weighted imaging,higher Cho/Cr ratio(OR=1.14,95%CI:1.08-1.20)and higher Cho/NAA ratio(OR=3.73,95%CI:1.50-9.35)in MR spectroscopy imaging were significantly associated with high grade(all P<0.05).ConclusionssFor patients with gliomas that show no enhancement on MRI,who are over the age of 40 and(or)have a tumor growth rate greater than 8 mm/year,there should be a high level of vigilance for the possibility of the lesion being of

关 键 词：神经胶质瘤 疾病特征 磁共振成像 无强化 高级别 

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]