脑胶质瘤的MRS及DWI成像的临床价值研究

Clinical value of glioma MRS and DWI imaging

目的 分析MRS（氮质子磁共振波谱成像）及DWI（弥散加权成像）在颅内胶质瘤病变中的表现特点和诊断价值以及对临床术前的应用价值。方法 对51例术后证实的胶质瘤患者行常规MRI平扫、DWI及MRI增强、多体素MRS检查,计算肿瘤实质区及对侧正常脑组织ADC值和代谢物NAA、Cho、Cr值及Cho/Cr、NAA/Cho、NAA/Cr等比值。结果 51例胶质瘤实质区NAA含量明显降低,Cho含量增高,Cr含量中等降低。Ⅰ~Ⅱ级组患侧与对侧比较NAA/Cr、Cho/Cr差异显著,有统计学意义（P〈0.05）;Ⅲ~Ⅳ级组患侧与对侧比较NAA/Cr、Cho/Cr差异显著,有统计学意义（P〈0.05）;两组间比较NAA/Cr、Cho/Cr差异显著,有统计学意义（P〈0.05）。两组胶质瘤实质区的ADC值均高于正常脑组织,差异具有统计学意义（P〈0.05）。Ⅲ~Ⅳ级组胶质瘤实质区ADC值低于Ⅰ~Ⅱ级组,且差异具有统计学意义（P〈0.05）。结论 联合多体素MRS及DWI对胶质瘤术前诊断、分级及选择手术方式有重要的临床意义。

Objective To analyze the performance characteristics and diagnostic value of MRS（ nitrogen proton magnetic resonance spectroscopic imaging） and DWI（ diffusion weighted imaging） in intracranial gliomas lesions and preoperational clinical value. Methods 51 cases who were confirmed as gliomas underwent normal examination such as conventional MRI scan,DWI and MRI enhancement,multi-voxel MRS. Calculation of tumor parenchyma and contralateral normal brain tissue ADC values and metabolites NAA,Cho,Cr value and Cho / Cr,NAA / Cho,NAA / Cr ratios,etc. Results NAA content of 51 cases of glioma parenchyma decreased,Cho levels increased,Cr content of the medium decreases. Grade Ⅰ ~ Ⅱ group ipsilateral and contralateral comparison NAA / Cr,Cho / Cr were significantly different,statistically significant（ P〈0. 05）; Ⅲ ~ Ⅳ level group ipsilateral and contralateral comparison NAA / Cr,Cho / Cr significant difference was statistically significant（ P〈0. 05）; Between the two groups NAA/Cr,Cho/Cr were significantly different,statistically significant（ P〈0. 05）. ADC values of the two groups of gliomas parenchyma were higher than normal brain tissue,the difference was statistically significant（ P〈0. 05）. Ⅲ ~ Ⅳ grade glioma group parenchyma ADC values below grade Ⅰ ~Ⅱ group,and the difference was statistically significant（ P〈0. 05）. Conclusions It is of important clinical significance to combine multi-voxel MRS with DWI for glioma patients before diagnosis,classification and choice of surgical approach.