MR多参数评分鉴别脑胶质瘤术后复发与放射性脑损伤的初步研究

MR Multi-parametric Scoring System in Distinction between Brain Glioma Recurrence and Radiation-induced Brain Injury:A Preliminary Study

目的探讨MR多参数评分系统对脑胶质瘤术后复发与放射性脑损伤的诊断价值。资料与方法对18例脑胶质瘤术后出现异常强化区患者进行扩散加权成像(DWI)、氢质子磁共振波谱(1H-MRS)检查。计算感兴趣区的表观扩散系数比值(rADC)和代谢物峰值比值[胆碱/肌酸(Cho/Cr)、胆碱/氮-乙酰天门冬氨酸(Cho/NAA)]。根据受试者工作特征(ROC)曲线确定各比值参数的最佳诊断阈值,并对每个病灶分别进行评分,联合多个参数(rADC、Cho/Cr、Cho/NAA)评分结果建立多参数评分系统,对每个病灶综合评分,总得分≥2者诊断为复发,总得分<2者诊断为放射性脑损伤。通过Kappa检验分析各参数诊断结果与金标准诊断结果的吻合程度。结果最佳诊断阈值分别为:1.41(rADC)、1.31(Cho/Cr)和1.43(Cho/NAA),诊断准确性、敏感性、特异性分别为:83.3%、83.3%、83.3%(rADC),83.3%、91.7%、66.7%(Cho/Cr),83.3%、83.3%、83.3%(Cho/NAA),多参数评分系统(94.4%、91.7%、100%);诊断结果与金标准吻合程度分别为:rADC(高度,κ=0.64)、Cho/NAA(高度,κ=0.64)、Cho/Cr(高度,κ=0.61)、多参数评分系统(极强,κ=0.87)。结论与MR单个参数诊断结果相比,MR多参数评分系统可明显提高对胶质瘤术后复发与放射性脑损伤的诊断准确性。

Objective To explore the value of MR multi-parametric scoring system in distinction between brain glioma recurrence and radiation-induced brain injury.Materials and Methods DW（Diffusion weighted）MR imaging and 1H MRS（1H Magnetic resonance spectroscopy）were obtained in eighteen postoperative patients with abnormal enhanced lesions.The ADC（apparent diffusion confficient）values of every lesion and contralateral normal white matter were measured,and ADC ratio（rADC,lesions/contralateral normal white matter）was calculated.Metabolite（NAA：N-acetyl aspartate,2.0 ppm;Cr：Creatine,3.03 ppm;Cho：Choline,3.2 ppm）peak height of every region of interest and metabolite peak ratio（Cho/Cr,Cho/NAA）were calculated.Optimum threshold was determined by using ROC（receiver operating characteristic）curve analysis.Each lesion was scored as 1（tumor progression）or 0（radiation-induced injury）according to its optimum threshold.A multi-parametric scoring system（ADC ratio,Cho/Cr ratio,Cho/NAA ratio）were established.Results Optimum threshold of ADC ratio,Cho/Cr ratio and Cho/NAA ratio were 1.41,1.31 and 1.41.Diagnostic accuracy,sensitivity and specificity of ADC ratio were 83.3%,83.3%,83.3%,those of Cho/Cr ratio were 83.3%,91.7%,66.7%,those of Cho/NAA ratio were 83.3%,83.3%,83.3%.Accuracy,sensitivity and specificity of multi-parametric scoring system were 94.4%、91.7%、100%.The match degree of the multi-parametric scoring system with the final diagnosis was strong（κ=0.87）.Conclusion Multi-parametric scoring system can significantly improve the accuracy in distinction glioma recurrence from radiation-induced brain injury.