联合应用单体素长TE ~1H-MRS与ADC在高级别胶质瘤与原发性中枢神经系统淋巴瘤中的鉴别价值

Valuation of Combination use of Single Voxel Long Echo ~1H-MRS and ADC in Distinguishing Primary Central Nervous System Lymphoma from High Grade Gliomas

目的探讨联合应用单体素长TE氢质子磁共振波谱成像(~1H-MRS)与表观扩散系数(ADC)在颅内高级别胶质瘤(HGG)与原发性中枢神经系统淋巴瘤(PCNSL)中的鉴别诊断价值。方法回顾性分析病理证实的15例颅内PCNSL组及26例HGG组的扩散系数成像(DWI)与磁共振波谱成像(MRS)图像,测量计算肿瘤病灶区(避开中心坏死区及瘤周水肿区)与镜面正常脑组织的ADC数值与单体素长TE ~1H-MRS N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr、Cho/NAA,使用两独立样本t检验对参数进行统计学分析,并绘制受试者工作特征(ROC)曲线,对单纯应用ADC、MRS及联合应用两种方法进行Logistics回归分析,并绘制ROC曲线。结果 41例肿瘤实质的ADC与单体素长TE ~1H-MRS各代谢参数比值与镜面正常脑组织相比均具有显著差异(P<0.05),其中除Cho/NAA外,其余参数在PCNSL与颅内HGG中均具有显著差异(P<0.05)。运用ROC分析,ADC与NAA/Cr、 Cho/Cr的曲线下面积(AUC)均大于0.5,联合应用MRS与ADC鉴别颅内PCNSL和HGG的AUC(0.93)大于单纯应用ADC(0.80)或MRS(0.85),敏感性为86.7%,特异性为96.2%。结论联合应用单体素长TE ~1H-MRS与ADC参数对HGG与PCNSL具有更高的鉴别诊断价值,具有较高的敏感度和特异度。

Objective To explore the value of Single voxel long echo ~1H-MRS and ADC in differentiating Primary Central Nervous system Lymphoma from High Grade Gliomas. Methods DWI and Single voxel long echo ~1H-MRS imaging of 15 cases with Primary Central Nervous system Lymphoma and 26 cases with High Grade Gliomas were retrospectively analyzed(pathologically confirmed). The ratio of metabolic parameters(NAA/Cr,Cho/Cr,Cho/NAA) and ADC of tumor lesion and contralateral normal area were measured and calculated. The statistical analyses(t-test and Logistics regression) and ROC curve were carried out. Results The differences of ADC,NAA/Cr,Cho/Cr and Cho/NAA between tumor lesions and contralateral normal area in all 41 cases were statistically significant(P<0.05). The ratio of NAA/Cr、Cho/Cr and ADC have statistical significance(P<0.05) in differentiating Primary Central Nervous system Lymphoma from High Grade Gliomas,when Cho/NAA has no statistical significance(P>0.05). The analysis of the subjects’ working curve(ROC curve) showed that the area under the curve of ADC 、NAA/Cr and Cho/Cr(AUC) in differentiating Primary Central Nervous system Lymphoma from High Grade Gliomas are all greater than 0.5. The AUC(0.93) of the combined application of MRS and ADC to differentiating Primary Central Nervous system Lymphoma from High Grade Gliomas is greater than that of ADC(0.80) or MRS(0.85),and the sensitivity and specificity values are 86.7% and 96.2%,respectively,when the boundary value was 0.45. Conclusion The combination use of Single voxel long echo ~1H-MRS(NAA/Cr、Cho/Cr) and ADC has higher sensitivity and specificity,which means a higher value in differentiating Primary Central Nervous system Lymphoma from High Grade Gliomas.