多模态磁共振成像技术在胶质瘤术后复发及放射性损伤诊断中的应用研究

Applicability Evaluation of Multimodal Magnetic Resonance Imaging in Distinguishing Radiation-induced Brain Injury from Recurrence of Glioma

目的:评价多模态磁共振成像技术在胶质瘤术后复发和放射性损伤诊断中的应用价值。方法:将2015年07月至2019年08月45例在我院诊治、且经手术病理证实为胶质瘤,且行多模态磁共振影像随访的患者进入研究。其中胶质瘤复发24例,放射性损伤21例。对入组的病例进行多模态磁共振成像的数据进行测定,建立联合预测胶质瘤复发的Logistic回归模型,通过受试者工作特征曲线(ROC曲线)对多模态磁共振成像参数及联合预测模型在胶质瘤术后复发的诊断效能进行评价。结果:入组病例的NAA/Cho、NAA/Cr、Cho/Cr及ADC值在胶质瘤术后复发及放射性损伤组间差异具有统计学意义(Z=4.835、3.618、-4.039、4.926,均P<0.001)。NAA/Cho及ADC值诊断效能相仿(AUC值分别为0.923、0.931),且均优于NAA/Cr及Cho/Cr(AUC值分别为0.816、0.853)。NAA/Cho及ADC值的联合预测胶质瘤术后复发的模型为:Logit(P)=18.159-1.607×NAA/Cho-17.863×ADC值。联合预测模型的AUC值为0.970,大于NAA/Cho(0.923)和ADC值(0.931)。NAA/Cho、ADC值及联合预测模型的诊断敏感度分别为91.67%、91.67%和87.50%,特异度分别为90.48%、90.48%和100%。结论:多模态磁共振成像技术联合应用对胶质瘤术后复发的诊断效能优于单独应用,值得临床推广运用。

Objective:To investigate the value of multimodal magnetic resonance Imaging in distinguishing radiation-induced brain injury from recurrence of glioma.Methods:The clinical and MRI materials of 45 patients of glioma treated in Suzhou Kowloon Hospital from July 2015 to August 2019 were enrolled in this study,including 24 cases with tumor recurrence and 21 cases of radiation-induced brain injury.The ADC value,NAA,Cho,Cr and other metabolite peaks were measured.A Logistic regression model(combined prediction model)was established.The diagnosis value of each parameter and combined prediction model for distinguishing radiation-induced brain injury from tumor recurrence was evaluated by receiver operating characteristic(ROC)curve.Results:The NAA/Cho,NAA/Cr,Cho/Cr and ADC value between patients with glioma recurrence and radiation-induced brain injury group were all statistically significant(Z=4.835,3.618,-4.039,4.926,all P<0.001).The area under the curve(AUC)of ROC in NAA/Cho and ADC value(AUC=0.923,0.931)was higher than that in NAA/Cr and Cho/Cr(AUC=0.816,0.853).The Logistic regression combined prediction model was Logit(P)=18.159-1.607*NAA/Cho-17.863*ADC value.The area under the curve(AUC)of ROC in the combined prediction model(0.970)was higher than that in NAA/Cho(0.923)and ADC value(0.931).The diagnostic sensitivity of NAA/Cho,ADC value and the model were 91.67%,91.67%and 87.50%,respectively;the diagnostic specificity were 90.48%,90.48%and 100%.Conclusion:Multimodal magnetic resonance imaging in distinguishing radiation-induced brain injury from tumor recurrence is superior to single application of them and worthy of promotion.