磁共振弥散张量成像联合磁共振波谱检查对脑神经胶质瘤临床分级、预后评估的价值分析  

Application of diffusion tensor imaging combined with magnetic resonance spectroscopy for clinical grading and prognosis assessment of brain glioma

作　　者：闫龙[1,3] 吴鹏 王生海[1] 宋延峰[1] 杨爱莲[2] Yan Long;Wu Peng;Wang Shenghai;Song Yanfeng;Yang Ailian(Department of CT Diagnosis,Yan'an People's Hospital,Yan'an 716000,Shaanxi Province,China;Department of Imaging,Yan'an Ansai District People's Hospital,Yan'an 716000,Shaanxi Province,China;Department of Imaging,Yan'an Hospital of Traditional Chinese Medicine,Yan'an 716099,Shaanxi Province,China)

机构地区：[1]延安市人民医院CT诊断科,延安716000 [2]延安市安塞区人民医院影像科,延安716000 [3]延安市中医医院影像科,延安716099

出　　处：《中国基层医药》2025年第3期336-341,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的分析磁共振弥散张量成像(DTI)联合磁共振波谱(MRS)检查对脑神经胶质瘤临床分级、预后评估的价值。方法回顾性分析延安市人民医院2010年1月至2023年12月收治的72例脑胶质瘤患者的临床资料,其中男40例,女32例;年龄范围25~76岁,年龄(40.3±6.8)岁;术前均行常规MRI平扫、增强扫描、磁共振弥散张量成像(DTI)、磁共振波谱(MRS)检查,并测量各向异性分数值(FA)、N-乙酰天冬氨酸(NAA)、胆碱复合物(Cho)、肌酐(Cr),计算NAA/Cho、Cho/Cr、NAA/Cr比值,剖析脑神经胶质瘤的影像学特征,分析上述指标对患者临床分级、预后评估的应用价值。结果72例患者中,DTI成像结果显示:瘤周脑白质纤维束破坏中断;MRS成像特征:近似正常,或见Cho、Cr值升高,NAA值下降。35例(48.61%)可出现弥漫性轻中度强化,呈斑片状,强化区代表肿瘤级别较高。低级别胶质瘤(LGG)、高级别胶质瘤(HGG)瘤周水肿区FA[(0.20±0.06)×10^(-3)mm^(2)/s比(0.62±0.08)×10^(-3)mm^(2)/s、(0.17±0.05)×10^(-3)mm^(2)/s比(0.62±0.09)×10^(-3)mm^(2)/s]、NAA/Cho[(0.36±0.11)比(1.41±0.33)、(0.19±0.06)比(1.42±0.35)]、Cho/Cr[(2.39±0.51)比(1.12±0.26)、(3.81±0.94)比(1.12±0.28)]、NAA/Cr值[(0.75±0.24)比(1.52±0.31)、(0.38±0.12)比(1.52±0.29)]与相应健侧区比较,差异均有统计学意义(t_(LGG)=26.56、19.09、14.03、12.42,t_(HGG)=27.64、21.90、17.34、22.97,均P<0.05);LGG、HGG间的FA[(0.20±0.06)×10^(-3)mm^(2)/s比(0.17±0.05)×10^(-3)mm^(2)/s]、NAA/Cho[(0.36±0.11)比(0.19±0.06)]、Cho/Cr[(2.39±0.51)比(3.81±0.94)]、NAA/Cr[(0.75±0.24)比(0.38±0.12)]值比较,差异均有统计学意义(t=2.26、7.85、8.17、7.95,均P<0.05)。术后6个月至3年进行随访显示:死亡组患者的Cho/Cr高于生存组[2.172(1.662,2.863)比2.729(2.431,3.689)](U=2.17,P<0.05),而FA、NAA/Cho、NAA/Cr值在生存组与死亡组间比较,差异无统计学意义(P>0.05)。结论DTI联合MRS可使脑神经胶质瘤显示特殊的影像学特征,为患�Objective To analyze the value of diffusion tensor imaging(DTI)combined with magnetic resonance spectroscopy(MRS)in the clinical grading and prognosis assessment of brain glioma.Methods A retrospective analysis was conducted on the clinical data of 72 patients with brain glioma admitted to Yan'an People's Hospital from January 2010 to December 2023.The cohort included 40 males and 32 females,with ages ranging from 25 to 76 years and an average age of(40.3±6.8)years.All patients underwent routine magnetic resonance imaging plain scans,contrast-enhanced ultrasound examination,DTI,and MRS prior to surgery.Measurements were conducted for fractional anisotropy(FA),N-acetyl aspartate(NAA),choline compounds(Cho),and creatinine(Cr).Additionally,the ratios of NAA/Cho,Cho/Cr,and NAA/Cr were calculated.The imaging characteristics of brain glioma were analyzed,and the clinical utility of these indicators for grading and prognosis assessment of brain glioma was evaluated.Results DTI results of the 72 included patients revealed disruption of the white matter fiber tracts surrounding the tumors.MRS of the 72 included patients showed either approximately normal values or indicated elevated Cho and Cr levels,along with decreased NAA levels.Diffuse mild to moderate enhancement was observed in 35 patients(48.61%),presenting with a patchy pattern that suggested a higher tumor grade.When comparing low-grade gliomas(LGG)and high-grade gliomas(HGG)to the corresponding healthy tissue,significant differences were observed in FA value in the peritumoral edema region[(0.20±0.06)×10^(-3)mm^(2)/s vs.(0.62±0.08)×10^(-3)mm^(2)/s for LGG,and(0.17±0.05)×10^(-3)mm^(2)/s vs.(0.62±0.09)×10^(-3)mm^(2)/s for HGG],NAA/Cho ratio[(0.36±0.11)vs.(1.41±0.33)for LGG,and(0.19±0.06)vs.(1.42±0.35)for HGG],Cho/Cr ratio[(2.39±0.51)vs.(1.12±0.26)for LGG,and(3.81±0.94)vs.(1.12±0.28)for HGG],and NAA/Cr ratio[(0.75±0.24)vs.(1.52±0.31)for LGG,and(0.38±0.12)vs.(1.52±0.29)for HGG].All observed differences were statistically significant(t_(LGG)=26.5

关 键 词：神经胶质瘤 弥散磁共振成像 磁共振波谱学 天冬氨酸 胆碱 预后 

分 类 号：R73[医药卫生—肿瘤]