多体素^(1)H-MRS联合ADC在脑胶质瘤分级诊断与瘤细胞增殖评估中的应用

Combine Application of Multi-Voxel~^(1)H-MRS and ADC in Brain Glioma Grading Diagnosis and Tumor Cell Proliferation Evaluation

目的探讨多体素氢质子磁共振波谱成像(^(1)H-MRS)联合表观扩散系数(ADC)在脑胶质瘤分级诊断、评估肿瘤细胞增殖活性的应用价值。方法60例脑胶质瘤患者,低级别胶质瘤(LGG)组(Ⅰ、Ⅱ级)22例,高级别胶质瘤(HGG)组(Ⅲ、Ⅳ级)38例。所有患者术前完成多体素^(1)H-MRS及扩散加权成像(DWI)检查。分析瘤体区胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、NAA/Cr、瘤体区表观扩散系数(ADC_(T))、对侧正常脑实质表观扩散系数(ADC_(H))、相对表观扩散系数(rADC)(rADC=ADC_(T)/ADC_(H))、Ki-67指数的统计学差异。结果LGG、HGG瘤体区Cho/Cr、Cho/NAA及ADC_(T)、rADC值的差异均有统计学意义(P<0.01);Cho/Cr联合rADC值的受试者工作特征曲线(ROC)曲线下面积(AUC)最大(AUC=0.92),脑胶质瘤分级诊断敏感度、特异度为92.1%、80.3%。瘤体区Cho/Cr、Cho/NAA值与Ki-67指数呈正相关(r分别为0.64、0.37,P<0.01),而ADC_(T)及rADC值与Ki-67指数呈负相关(r分别为-0.65、-0.64,P<0.01)。结论^(1)H-MRS联合ADC值不仅可提高脑胶质瘤分级诊断效能,还可用于评估肿瘤细胞分裂增殖活性。

Objective To investigate the application value of Multi voxel~^(1)H-MRS combined with apparent diffusion coefficient(ADC)in glioma grading diagnosis and tumor cell proliferative activity evaluation.Methods 60 patients with glioma,including 22 cases in the low grade glioma group(gradeⅠ~Ⅱ)and 38 cases in the high grade glioma group(gradeⅢ~Ⅳ).All patients underwent multi voxel~^(1)H-MRS and DWI before surgery.The statistical differences of Cho/Cr,Cho/NAA,NAA/Cr,ADCT,ADCH,rADC and Ki 67 index in tumor area were analyzed.Results The values of Cho/Cr,Cho/NAA,ADCT,rADC between high grade and low grade gliomas had significant differences(P<0.01).The area under the curve(AUC=0.92)of Cho/Cr combined with rADC was the largest,the sensitivity and specificity for glioma grading diagnosis were 92.1%,80.3%.Ki-67 index showed a positive correlation with Cho/Cr and Cho/NAA values in tumor area(r were 0.64、0.37,respectively,P<0.01),while it showed a negative correlation with ADCT and rADC values(r were-0.65、-0.64,respectively,P<0.01).Conclusion Multi voxel~^(1)H-MRS combined with ADC values could not only improve the efficiency of glioma grading diagnosis,but also be used to evaluate the activity of tumor cell proliferation.