磁共振MRS、DWI及SWI序列在脑胶质瘤分级诊断中的应用价值

The application value of magnetic resonance MRS,DWI and SWI sequences in the grading diagnosis of glioma

目的探讨氢质子磁共振波谱分析(^(1)H-MRS)、扩散加权成像(DWI)及磁敏感加权成像(SWI)在胶质瘤分级诊断中的应用价值。方法收集2016年12月——2020年3月浙江省台州医院经手术或活检病理证实的胶质瘤患者共76例,按照2016版WH0中枢神经系统肿瘤分类标准,将所有病例分为低级别组(I~II级,31例)和高级别组(I~IV级,45例)。原始数据利用GEADW4.5工作站Functool软件处理,分别选取磁共振波谱(MRS)、DWI及SWI软件,测量肿瘤实质区MRS主要代谢物(胆碱.肌酸、氮-乙酰天门冬氨酸)并测算出比值、表观扩散系数(ADC)及肿瘤磁敏感信号强度(ITSS),并采用Mann-Whitney U检验对2组结果进行统计分析。结果低级别脑胶质瘤组Cho/NAA中位数为1.780,Cho/Cr中位数为1.920,NAA/Cr中位数为0.930,ADC值中位数为1.730x10^(-3)mm^(2)/s,ITSS评分中位数为1.0。高级别脑胶质瘤组Cho/NAA中位数为4.390,Cho/Cr中位数为3.560,NAA/Cr中位数为0.780,ADC值中位数为1.030x 10^(-3)mm^(2)/s,ITSS评分中位数为2.0。2组Cho/NAA.Cho/Cr、NAA/Cr、ADC值及ITSS评分比较差异均有统计学意义(均P<0.001)。结论MR多模态成像(MRS、DWI及SWI)在胶质瘤分级诊断中有重要的应用价值。

Objective To investigate the application value of 1H-magnetic resonance spectroscopy(1H-MRS),diffusion weighted imaging(DWI)and susceptibility weighted imaging(SWI)in the grading diagnosis of glioma.Methods Seventy-six cases of glioma confirmed by surgery or biopsy in our hospital were collected.According to the 2016 Edition of the WHO classification standard of the central nervous system tumors,the cases were divided into low-level group of glioma(Ⅰ-Ⅱ,31 cases)and the high-level group of glioma(Ⅲ-Ⅳ,45 cases).The original data were processed with the Functool software of GE ADW 4.5 workstation.MRS,DWI and SWI mapping software were selected to measure the main metabolites including choline(CHO),creatine(CR)and N-acetylaspartate(NAA)in the tumor parenchymal area of MRS and calculated the ratio,apparent diffusion coefficient(ADC)and intertumoral susceptibility signal(ITSS).Statistical analysis was performed on the results of the two groups with Mann-Whitney U Test.Results In the low-grade glioma group and high-grade glioma group,the Cho/NAA ratios were 1.780 and 4.390,the Cho/Cr ratios were 1.920 and 3.560,and the NAA/Cr ratios were 0.930 and 0.780,respectively.ADC values were 1.730×10^(-3) mm^(2)/s and 1.030×10^(-3) mm ^(2)/s,ITSS scores were 1.0 and 2.0,respectively.The differences of Cho/NAA,Cho/Cr,NAA/Cr,ADC and ITSS scores were statistically significant between two groups(all P<0.001).Conclusion MR multimodal imagings(MRS,DWI and SWI)show important application value in the grading diagnosis of glioma.