磁共振DTI和多体素~1H-MRS在胶质瘤术前分级中的联合应用

Combined application of magnetic resonance DTI and multi-voxel ~1H-MRS in preoperative classification of glioma

目的探讨MR弥散张量成像(DTI)和多体素氢质子MR波谱(~1H-MRS)在胶质瘤术前分级诊断中的临床联合应用价值。方法回顾分析我院经病理证实的38例胶质瘤术前常规MR、DTI和~1H-MRS资料,其中低级别胶质瘤(LGG,WHO Ⅱ级)15例,高级别胶质瘤(HGG,WHO Ⅲ~Ⅳ级)23例。以肿瘤周围脑实质为种子点重建弥散张量纤维束成像(DTT)图。测量肿瘤实质区(TT)、瘤周区(AT)以及对侧正常脑组织区(CT)的各项异性指数(FA)、平均弥散系数(MD)和胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天冬氨酸(NAA)、NAA/Cr值。比较组内同一参数在不同组织间差异,并比较各参数值在两组间的差异。结果 DTT显示HGG的TT和AT区白质纤维束以破坏为主(19/23,82.6%),LGG以浸润为主(13/15,86.7%)。HGG组由TT、AT至CT区FA、MD、NAA/Cr逐渐增高,Cho/Cr、Cho/NAA逐渐降低(P<0.05)。LGG组TT区FA、MD、NAA/Cr低于AT和CT区,Cho/Cr、Cho/NAA相反(P<0.05)。HGG组TT和AT区MD、NAA/Cr均低于LGG组,Cho/Cr、Cho/NAA均高于LGG组(P<0.05)。HGG组FA值仅在AT区低于LGG组(P<0.05)。结论临床可联合应用DTI和多体素~1H-MRS各参数对胶质瘤术后进行分级诊断,从而有助于及时合理的选择个体化治疗方案。

Objective To explore the clinical combined application value of MR diffusion tensor imaging(DTI)and multi-voxel proton MR spectroscopy(1H-MRS)in preoperative classification diagnosis of glioma.Methods We retrospectively analysed regular MR,DTI and 1H-MRS images of 38 patients with pathology confirmed glioma from the our hospital,which included 15 cases of low grade glioma(LGG,WHO II)and 23 cases of high grade glioma(HGG,WHO III^IV).We reconstructed the diffusion tensor tractography(DTT)images based on the seed points of brain tissue around the tumor,measured fractional anisotropy(FA),mean diffusion coefficient(MD),choline(Cho)/creatine(Cr),Cho/N-acetylaspartate(NAA),NAA/Cr values of tumor tissue(TT),brain tissue around tumor(AT)and contralateral normal brain tissue(CT),and compared the differences of each parameter among different tissues in group,and the differences of each parameter between groups.Results DTT images showed white matter fiber tracts of TT and AT were disrupted(19/23,82.6%)mostly in HGG,invaded(13/15,86.7%)mostly in LGG.In HGG group,the FA,MD and NAA/Cr were gradually increased,Cho/Cr and Cho/NAA were gradually decreased from TT,AT to CT(P<0.05).In LGG group,the FA,MD and NAA/Cr of TT were lower than that of AT and CT,the Cho/Cr and Cho/NAA were opposite(P<0.05).The MD and NAA/Cr of HGG were lower,the Cho/Cr and Cho/NAA of HGG were higher than that of LGG on TT and AT(P<0.05).The FA of HGG was lower than that of LGG only at AT area(P<0.05).Conclusion Clinic can combinedly apply the parameters of DTI and multi-voxel 1H-MRS to do preoperative classification diagnosis of glioma,which could be benefit for timely selecting more reasonable individualized treatment project.