磁共振功能成像在脑胶质瘤诊断中的应用价值

The value of magnetic resonance imaging in glioma

目的:探讨磁灌注加权(PWI)、扩散张量纤维束(DTI)、氢质子共振波谱(~1H-MRS)成像扫描在脑胶质瘤术前分级诊断中的价值。方法:收集经手术病理确诊为脑胶质瘤的48例患者临床资料,患者均术前行PWI、DTI、~1H-MRS扫描检查,测量瘤实质区、瘤周围水肿区及健侧CBV、CBF、FA、代谢物质成分及比值,并进行白质纤维束示踪成像(DTT),依据术前三种功能成像结果对胶质瘤级别进行判断。结果:48例胶质瘤瘤实质区及周围水肿区CBV、CBF值显著高于健侧白质区,FA值低于健侧白质区;瘤实质区CBV、CBF值显著高于瘤周围水肿区,FA值低于瘤周围水肿区(P<0.05)。高级别瘤实质区和周围水肿区rCBV、rCBF值均显著高于低级别(P<0.05);但rFA值在高低级别间差异无统计学意义(P>0.05)。高低级别患侧Cho/Cr、Cho/NAA值均显著高于健侧,NAA/Cr值显著低于健侧,且高级别患侧Cho/Cr、Cho/NAA显著高于低级别,NAA/Cr值显著低于低级别(P<0.05)。综合三种功能成像对脑胶质瘤诊断的正确率达93.75%。结论:PWI、DTI、~1H-MRS在脑胶质瘤诊断中各有优势,术前联合应用三种磁共振功能成像技术可更准确的判断胶质瘤级别。

Objective:To explore the value of magnetic perfusion weighting(PWI),diffusion tensor fiber bundle(DTI)and hydrogen proton resonance spectroscopy(1 H-MRS)imaging scan in preoperative grading diagnosis of glioma.Methods:Collecting clinical data of 48 patients diagnosed as glioma by surgical pathology.All patients underwent PWI,DTI,1H-MRS scan before surgery.The tumor parenchymal area,the edema area around the tumor and the healthy side CBV,CBF,FA,metabolite composition and ratio,and white matter fiber bundle tracing imaging(DTT)were performed,and the glioma grade was performed according to the results of preoperative three functional imaging.Results:The CBV and CBF values of 48 glioma parenchyma and surrounding edema area were significantly higher than that of the healthy white matter area,and the FA value was lower than that of the healthy white matter area;The CBV and CBF values in the parenchymal region were significantly higher than those in the edema around the tumor,and the FA value was lower than that in the edema around the tumor(P<0.05).The rCBV and rCBF values in the high-grade tumor parenchyma and surrounding edema were significantly higher than the low-grade tumor(P<0.05).However,there was no significant difference in rFA between the high and low-grade tumor(P>0.05).The levels of Cho/Cr and Cho/NAA in the high and low-grade tumor were significantly higher than those in the healthy side,the NAA/Cr value was significantly lower than that in the healthy side,and the Cho/Cr and Cho/NAA in the high-grade tumor were significantly higher than the lower-grade tumor.NAA/Cr values were significantly lower than the low-grade tumor(P<0.05).The correct rate of diagnosis of glioma by three functional imaging was 93.75% .Conclusion:PWI,DTI,and 1 H-MRS have their own advantages in the diagnosis of glioma.Preoperative combination of three magnetic resonance imaging techniques can more accurately determine glioma grade.