多体素磁共振波谱成像在诊断神经上皮组织起源肿瘤中的应用价值

Clinical application of multivoxel MR spectroscopy in the diagnosis of neuroepitheliogenic tumors

目的评价多体素磁共振波谱成像对神经上皮组织起源肿瘤诊断的应用价值,预报神经上皮组织起源肿瘤的病理类型及级别,为临床制定治疗方案和判断预后提供有效信息。方法对25例不同级别神经上皮组织起源肿瘤患者的手术前常规MRI及多体素磁共振波谱检查资料进行回顾分析,并与手术后病理结果相比较。根据肿瘤中心、周边区域及对侧正常区域N鄄乙酰天冬氨酸(N鄄acetylaspar鄄tate熏NAA)和胆碱(choline熏Cho)代谢物峰下积分值,计算Cho/NAA比值,分别比较肿瘤中心及周边区域Cho/NAA比值与对侧正常区域的差异(配对秩和检验),以及不同级别肿瘤之间肿瘤中心及周边区域Cho/NAA比值的差异。结果与对侧正常区域Cho/NAA比值(0.68±0.19)相比,肿瘤中心(4.50±4.94)和周边区域(1.07±0.39)Cho/NAA比值明显增高,差异有高度统计学意义(P<0.01)。肿瘤中心Cho/NAA比值,低级别肿瘤组为(2.17±0.88),高级别组(6.22±5.86);肿瘤周边区域Cho/NAA比值,低级别组为(0.84±0.22),高级别组(1.23±0.41),组间差异有统计学意义(P<0.05或P<0.01)。结论多体素磁共振波谱成像作为一种无创、简便、直观的活体代谢检查技术,对神经上皮组织起源肿瘤病理级别的诊断具有较高的准确性和实用价值。随着该技术在临床应用过程中的不断改进与完善,必将成为神经上皮组织起源肿瘤无可替代的重要影像学检查方法之一。

Objective To evaluate the clinical application value of multivoxel MR spectroscopy in neuroepitheliogenic tumors in order to predict their pathological classification, grading and afford the effective information for scheduling the therapeutic regimen and evaluating the prognosis. Methods A total of 25 admitted patients with neuroepitheliogenic tumors performed conventional MRI and muhivoxel MR spectroscopy preoperationally, then the date were retroperspectively analyzed and compared with postoperational pathological examination. The metabolite under peak integral value of N-acetylaspartate （NAA）, choline （Cho） in the central area of the tumor, contralateral normal brain tissues, and peripheral area adjacent to the tumor and the Cho/NAA ratios were calculated respectively. Matched rank sum test was used to compare the Cho/NAA ratio of central area and peripheral region of the tumor with that ratio in contralateral normal brain tissues respectively. Then t＇test was performed in lower and higher grade group for comparing Cho/NAA ratio in the central area of the tumor and peripheral region of tumor respectively. Results The Cho/NAA ratios of the central area of the tumor, contralateral normal brain tissues, and peripheral area were （4.50±4.94）, （0.68±0.19） and （1.07±0.39） respectively. The difference of Cho/NAA among the central area, peripheral area of the tumor and contralateral normal brain tissues were statistically significant （P〈 0.01）. The Cho/NAA of the central area and peripheral area in the lower grade group and higher grade group were （2.17±0.88）, （6.22±5.86） and （0.84±0.22）, （1.23±0.41） respectively. The statistically significant difference was found （P〈 0.05 or P〈 0.01） in t’test. Conclusion Multivoxel MR spectroscopy imaging is a noninvasive, convenient, intuitional examination for vital metabolism with more accuracy and practical value in the diagnosis of neuroepitheliogenic tumors. Along with technique improvement and perfection in the clinical application, it should become an unsubstitutional imaging technique in the diagnosis of neuroelpitheliogenic tumors.