多模式磁共振在脑胶质瘤放射性坏死与复发鉴别中的应用

The role of differential diagnosis between radiation necrosis and glioma recurrence using multi-modality magnetic resonance imaging

目的:主要探讨多模式磁共振包括DTI、T2*-PWI、1H-MRS在提高脑胶质瘤复发与放射性坏死鉴别诊断中的应用价值。方法:收集24例病例,15例为放射性坏死,9例为脑胶质瘤复发,在传统平扫及增强的基础上行DTI、T2*-PWI、1H-MRS。分别重建病灶及正常对侧的神经纤维束,并以病灶强化区、水肿区及正常对照区为感兴趣区,得到nrCBV值及Cho/Cr、NAA/Cr、Cho/NAA的比值。以独立样本t检验比较各参数,P<0.05为差异有统计学意义。结果:脑胶质瘤复发强化区与水肿区nrCBV值均高于放射性坏死,强化区nrCBV值的诊断敏感性及特异性分别为88.2%和97.4%,而水肿区为92.3%和100%。脑胶质瘤复发强化区与水肿区Cho/Cr、Cho/NAA比值明显高于放射性坏死,强化区Cho/Cr比值的诊断敏感性及特异性分别为93.3%和100%,而水肿区为66.7%和88.9%;强化区Cho/NAA比值的敏感性及特异性分别为86.7%和100%,而水肿区为73.3%和77.8%。结论:利用DTI、T2*-PWI、1H-MRS等多模式磁共振可以明显提高脑胶质瘤复发与放射性坏死鉴别诊断的正确率。

Objective：To investigate the value of DTI,T2＊-PWI,1H-MRS in the differential diagnosis between the glioma recurrence and radiation necrosis.Methods：The imaging features on the above sequences in 15 cases of radiation necrosis and 9 cases of glioma recurrence were studied retrospectively.The nrCBV values,Cho/Cr,NAA/Cr,and Cho/NAA ratios in the enhancing part,peri-local edema,and contralateral normal white matter were measured,and the nerve fiber of the lesions and normal contralateral white matter was reconstn1cted.Results：The nrCBV values,Cho/Cr and Cho/NAA ratios in the enhancing part and peri-local edema of glioma recurrence were higher than those of radiation necrosis.The sensitivity and specificity of the Cho/Cr ratios in the enhancing part were 93.3％ and 100％,and in the peri-local edema,they were 66.7％ and 88.9％.The Cho/NAA ratios,in corresponding location,were 86.7％ and 100％,73.3％ and 77.8％.There were no statistically differences in the NAA/Cr ratios （P＞0.05）.Conclusion：The multi-modality magnetic resonance imaging,including DTI,T2＊-PWI,1H-MRS can significantly improve the differential diagnosis between glioma recurrence and radiation necrosis.