波谱分析和磁共振灌注成像在胶质瘤复发诊断中的价值

Value of MR spectroscopy and MR perfusion imaging in brain tumor recurrence diagnosis

目的:目前对高级别胶质瘤复发的诊断难度较大,尤其是放化疗后放射性坏死和肿瘤复发鉴别更为困难,波谱分析(MR spectroscopy,MRS)是目前唯一能无创性定性定量提供活体内生化信息的方法,对颅内肿瘤的诊断有一定的意义,磁共振灌注成像(MR perfusion imaging,MR灌注)能有效反应局部血管情况,所以本研究为探讨MRS和MR灌注在脑内高级别胶质瘤复发中的诊断价值。方法:选取哈尔滨医科大学附属第二医院2007年7月-2013年12月收治的96例经过病理证实为脑胶质瘤的病例,均为接受手术治疗及术后放化疗,并且再次手术病例,结合新的病理结果、MRS和MR灌注,进行回顾性分析。结果:MRS的真阳性率为77.38%(65/84),假阳性率为22.62%(19/84),真阴性率为58.33%(7/12),假阴性率为41.67%(5/12)。MR灌注的真阳性率为78.82%(67/85),假阳性率为21.18%(18/85),真阴性率为54.55%(6/11),假阴性率为45.45%(5/11)。通过不同分级的对比,MRS、MR灌注的结果相一致的有52例,结果不一致的有44例。通过McN emar检验分析,两者差异有统计学意义(P<0.05)。总体上MRS对高级别胶质瘤的敏感度为92.86%,特异度为26.92%,准确度为75.00%;而MR灌注的敏感度略高为93.05%,特异度略低为25.00%,准确度略高为76.40%。把两个检测设置为并联,其联合灵敏度为99.50%,联合特异度为6.73%。结论:总体上MRS、MR灌注对高级别胶质瘤的敏感度、特异度及准确度结果较为接近。两种检查明显有互补性,并联后可以明显提高敏感性,串联后可以明显提高特异度。MRS和MR灌注在高级别胶质瘤复发的诊断中有互补性,能更有效的提高临床诊断的准确度和特异度。

Objective： It is difficult to diagnose the recurrence of high grade/level glioma now. It＇s more difficult to distinguish tumor recurrence from the radiation - induced scar tissue or necrosis. Magnetic resonance spectroscopy （MRS） ,which provides biochemical information in vivo as the only approach to noninvasive quantitative,has an im- portant significance to the diagnosis and differential diagnosis of intracranial tumors. Magnetic resonance perfusion im- aging can effectively reflect the local blood vessels. This study discusses the diagnostic value of MRS and MR perfu- sion imaging in the recurrence of the high - grade glioma. Methods ： Retrospective investigation and analysis were carried out in 96 cases of cerebral gliomas ,which were treated in Second Affiliated Hospital of Harbin Medical Univer- sity from July 2007 to December 2013. All patients were treated with surgery, radiotherapy and chemotherapy and the secondary surgery,tested by new pathological findings, MRS and MR perfusion. Results：The true positive rate of MRS was 77.38% （65/84）, the false positive rate was 22.62% （ 19/84）, true negative rate was 58.33% （7/12）, false negative rate was 41.67% （5/12）. The true positive rate of MR perfusion was 78.82% （67/85） ,false positive rate 21.18 % （ 18/85 ）, true negative rate 54.55 % （6/11）, false negative rate 45.45 % （5/11 ）. Through the comparison of different classification,52 cases showed consistent results for MRS and MR perfusion, and 44 cases showed inconsis- tent results. By the McNemar test analysis, the difference was statistically significant （ P 〈 0.05 ）. The sensitivity of MRS was 92.86% , specificity was 26.92% , and accuracy was 75.00%. The sensitivity of MR perfusion was 93.05% ,slightly higher than MRS. The specificity was 25.00% ,lower than MRS. The accuracy was 76.40% ,slightly higher than MRS. Conclusion：The sensitivity, specificity and accuracy of MRS and MR perfusion imaging are consis- tence. This two kinds of inspection method are complementary to each other. Parallel tests can increase the diagnostic sensitivity obviously, while series tests can obviously increase the diagnostic specificity. MRS and MR perfusion ima- ging of high grade glioma diagnosis are of important value.