多体素磁共振波谱成像在舌癌诊断中的应用及临床价值

Application and clinical value of multi-voxel magnetic resonance spec troscopy in the diagnosis of tongue carcinoma

目的·探讨多体素磁共振波谱成像(multi-voxel magnetic resonance spectroscopy,MVMRS)在舌癌诊断中的应用及临床价值。方法·回顾性分析2017年1—12月间56例经病理诊断为单侧舌原发鳞状细胞癌(鳞癌)或腺样囊腺癌(腺癌)患者病灶中代谢产物MVMRS波谱曲线特征。比较鳞癌组或腺癌组肿瘤实质区、环肿瘤区与健侧对照区间表观弥散系数(apparent diffusion coeffi cient,ADC)及代谢产物胆碱(choline,Cho)、肌酸(creatine,Cr)、胆碱/肌酸比值(Cho/Cr)、乳酸/脂质(lactate and lipids,LL)信号强度的差异;比较鳞癌组与腺癌组相应区域间ADC值及代谢产物信号强度的差异;观察2组各区域内Cho、LL信号强度与ADC值的相互关系。结果·鳞癌组和腺癌组肿瘤实质区代谢产物Cho、LL信号强度均高于各自的环肿瘤区和健侧对照区(均P=0.000),而ADC值则低于各自的环肿瘤区和健侧对照区(均P=0.000);环肿瘤区的Cho、LL信号强度和ADC值介于各自的肿瘤实质区和健侧区之间(均P=0.000);不同区域Cr和Cho/Cr信号强度差异无统计学意义(均P>0.01)。鳞癌组与腺癌组相应区域间ADC值、代谢产物信号强度差异无统计学意义(均P>0.01)。鳞癌肿瘤实质区内LL峰信号强度与ADC值呈线性负相关(P=0.000)。结论·MVMRS可以检测舌癌中肿瘤代谢产物的含量,环肿瘤区内ADC值和Cho、LL信号强度的改变可反映出受肿瘤侵犯的程度。

Objective · To determine clinical value of multi-voxel magnetic resonance spectroscopy （MVMRS） in the diagnosis of tongue carcinoma. Methods · A total of 56 cases that were pathologically diagnosed as having unilateral squamous cell carcinoma （SCC） or adenoid cystadenocarcinoma （ACC）, from January to December 2017, were selected in this retrospective study. The characteristics of metabolic profles in MVMRS were analyzed. The signals of choline （Cho）, creatine （Cr）, choline creatine ratio （Cho/Cr）, and lactate/lipids （LL） and the apparent diffusion coeffcient （ADC） were comparatively analyzed among the tumor parenchymal area, the paratumor area, and the contralateral control area in SCC/ACC group. The above indexes in the relative areas between SCC and ACC were also compared. Moreover, the relationship between the LL or Cho signal intensity with ADC in all the areas of two groups was investigated. Results · Higher Cho and LL signals were observed in the tumor parenchymal areas than those in the paratumor areas and the contralateral control areas in both SCC and ACC groups （P=0.000）, while ADC values in the tumor parenchymal areas were obviously lower （P=0.000）. Cho and LL signal intensities and ADC values in the paratumor areas were between the tumor parenchymal areas and contralateral control areas in both groups （P=0.000）. However, no signifcant difference among the areas in Cr or Cho/Cr signal was found （P〉0.01）. There was no signifcant difference between SCC and ACC groups in the relative areas, either （P〉0.01）. The signal intensity of LL in the tumor parenchymal area in SCC group was negatively linearly correlated with the ADC value （P=0.000）. Conclusion · MVMRS can detect the content of metabolites in tongue carcinoma, and LL and Cho signal intensities with ADC value can refect the degree of tumor invasion in the paratumor areas.