DWI联合MRS对脑胶质瘤分级诊断的价值

Value of DWI combined with MRS in glioma grade diagnosis

目的研究分析磁共振扩散加权成像(diffusion-weighted magnetic resonance imaging,DWI)联合氢质子磁共振波谱(hydrogen proton magnetic resonance spectroscopy,MRS)对脑胶质瘤分级诊断的价值。材料与方法选取2017年1月至2018年12月经病理证实的92例脑胶质瘤患者作为研究对象,并根据患者级别高低进行分组,其中Ⅰ至Ⅱ级的45例患者作为低级别胶质瘤组,Ⅲ至Ⅳ级的47例患者作为高级别胶质瘤组,并采用DWI以及MRS进行检查,比较两组患者影像学参数[扩散系数(apparent diffusion coefficient,ADC)值、N-乙醇天门东氨酸(N-ethanol tianmendong,NAA)、肌酸(creatine,Cr)及含胆碱(choline,Cho)],并分析DWI联合MRS诊断不同级别脑胶质瘤的诊断价值。结果低级别组患者ADC(11.52±1.0)×10^-3 mm^2/s、NAA/Cr明显高于高级别组ADC[(8.69±1.11)×10^-3 mm^2/s,t=12.332,P<0.05]、NAA/Cr(t=18.999,P<0.05),高级别组患者Cho/Cr、Cho/NAA明显高于低级别组Cho/Cr(t=34.164,P<0.05)、Cho/NAA(t=40.962,P<0.05)。以患者病理诊断结果作为金标准,DWI单项检查灵敏度为77.78%,特异度为76.60%,准确度为77.17%;MRS单项检查灵敏度为86.67%,特异度为80.85%,准确度为83.70%,DWI联合MRS检查灵敏度为93.33%,特异度为95.74%,准确度为94.57%,比较三组诊断方式具有统计学意义(P<0.05),DWI单项检查与MRS单项检查诊断价值明显低于DWI联合MRS检查,差异具有统计学意义(P<0.05)。结论DWI联合MRS对脑胶质瘤分级诊断具有很高价值,能够为临床治疗方案的制定以及判断预后提供帮助。

Objective:To analyze the value of diffusion weighted imaging(DWI)combined with hydrogen proton magnetic resonance spectroscopy(MRS)in glioma grade diagnosis.Materials and Methods:Between January 2017 and December 2018,92 patients with glioma were selected as subjects,and grouped according to the results of DWI and MRS,of which 45 patients with gradeⅠtoⅡwere classified into low-grade glioma group and 47 patients with gradeⅢtoⅣwere classified into high-grade glioma group.All patients received DWI and MRS examinations.Various indexes were compared between groups,including apparent diffusion coefficient(ADC)value,N-acetylaspartate(NAA),creatine(Cr)and choline(Cho).The diagnostic value of DWI combined with MRS in different grades of gliomas was analyzed.Results:The ADC[(11.52±1.0)×10^-3 mm^2/s]and NAA/Cr in the low-grade group were significantly higher than those in the high-grade group ADC[(8.69±1.11)×10^-3 mm^2/s]and NAA/Cr(t=12.332,P<0.05;t=18.999,P<0.05).The Cho/Cr and Cho/NAA in the highgrade group were significantly higher than those in the low-garde group(t=34.164,P<0.05;t=40.962,P<0.05).Taking pathological diagnosis as gold standard,the sensitivity,specificity and accuracy of DWI examination were 77.78%,76.60%,and 77.17%,respectively;the sensitivity,specificity and accuracy of MRS examination were 86.67%,80.85%,and 83.70%;the sensitivity,specificity and accuracy of DWI combined with MRS were 93.33%,95.74%and 94.57%(P<0.05).The diagnostic value of DWI and MRS was significantly lower than that of DWI combined with MRS(P<0.05).Conclusions:DWI combined with MRS parameters have certain clinical guiding value in glioma grade diagnosis with high sensitivity and specificity,which can provide some reference for clinical treatment and prognosis.