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目的探讨联合应用氢质子磁共振波谱(1H-MRS)相关代谢物和磁共振扩散加权成像(DWI)的表观扩散系数(ADC)值在脑胶质瘤分级诊断中的诊断价值。方法回顾性分析经病理证实的59例脑胶质瘤的MRS和DWI图像。按照WHO 2007标准,将病例分为两组:低级别胶质瘤组(Ⅰ~Ⅱ级,24例)和高级别胶质瘤组(Ⅲ~Ⅳ级,35例),测量并计算肿瘤实质区、健侧脑组织区代谢物及ADC值的相对值和比值,作统计学分析。结果在59例脑胶质瘤中,r NAA、Cho/Cr、NAA/Cr、NAA/Cho及r ADC在低、高级别组胶质瘤比较中差异均有统计学意义(P<0.05),而r Cho和r Cr在两组胶质瘤比较中差异无统计学意义(P>0.05);经受试者工作特征曲线分析发现r NAA、NAA/Cr、NAA/Cho、r ADC鉴别胶质瘤分级的曲线下面积>0.5,MRS+r ADC鉴别胶质瘤分级的曲线下面积(0.956)>单独运用MRS(0.893)或r ADC的曲线下面积(0.805),MRS+r ADC诊断低、高级别胶质瘤的敏感性和特异性分别达88.6%、95.8%。结论联合分析MRS参数(r NAA、NAA/Cr、NAA/Cho)和DWI参数(r ADC)对诊断胶质瘤分级具有较高的敏感性和特异性,可为临床治疗方案的制定及判断预后提供帮助。
Objective To investigate the diagnostic value of apparent diffusion coefficient (ADC) values of 1H-MRS-related metabolites and diffusion weighted imaging (DWI) in the diagnosis of gliomas. Methods The MRS and DWI images of 59 gliomas confirmed by pathology were retrospectively analyzed. According to WHO 2007, the patients were divided into two groups: low grade glioma group (Ⅰ ~ Ⅱ grade, 24 cases) and high grade glioma group (Ⅲ ~ Ⅳ grade, 35 cases) , The contralateral brain tissue metabolites and ADC values relative value and ratio for statistical analysis. Results In 59 cases of gliomas, there were significant differences in r NAA, Cho / Cr, NAA / Cr, NAA / Cho and r ADC between low and high grade gliomas (P <0.05) However, r Cho and r Cr had no significant difference between the two groups (P> 0.05). According to the working characteristic curves of the patients, r NAA, NAA / Cr, NAA / Cho and r ADC were used to identify gliomas The area under the curve for classification was> 0.5. The area under the curve (0.956) for differentiating gliomas by MRS + r ADC> area under the curve (0.805) with MRS (0.893) or r ADC alone was lower for MRS + The sensitivity and specificity of grade glioma were 88.6% and 95.8% respectively. Conclusions The combined analysis of MRS parameters (r NAA, NAA / Cr, NAA / Cho) and DWI parameters (r ADC) has a high sensitivity and specificity for the diagnosis of glioma grading, which can be used in clinical treatment planning and prognosis provide help.