^(1)H-MRS和3D-ASL技术在脑胶质瘤分级诊断中的应用价值

The Value of^(1)H-MRS and 3D-ASL in Grading Diagnosis of Glioma

目的探讨磁共振氢质子波谱成像(^(1)H-MRS)与三维动脉自旋标记(3D-ASL)成像参数在脑胶质瘤术前分级诊断中的应用价值。方法选取经病理证实的38例脑胶质瘤患者,其中低级别胶质瘤组19例,高级别胶质瘤组19例,所有患者均行^(1)H-MRS及3D-ASL扫描,将所得原始数据经后处理软件处理获得^(1)H-MRS代谢物比值(NAA/Cr、Cho/Cr、Cho/NAA、MI/Cr、Lac/Cr)与脑血流量(CBF)图谱,测量并计算感兴趣区参数值,所测参数值均采用SPSS软件进行分析,用两样本独立t检验比较两组间的各个参数值,以P<0.05为差异具有统计学意义;利用ROC曲线获得^(1)H-MRS、3D-ASL和两技术联合诊断的敏感度、特异度、AUC值、约登指数。结果高级别组的Cho/Cr、Cho/NAA、Lac/Cr、CBF值[4.160±0.946、4.362±1.070、4.720±4.856、(84.733±15.133)mL/(min·100g)]高于低级别胶质瘤组[2.074±0.401、2.143±0.592、0.925±0.525、(48.483±7.795)mL/(min·100g)],其差异具有统计学意义(P<0.05);高级别组的NAA/Cr值(0.746±0.273)低于低级别组(0.907±0.262),差异不具有统计学意义(P>0.05);高级别组的MI/Cr值(0.377±0.191)略高于低级别组(0.359±0.178),其差异不具有统计学意义(P>0.05);基于ROC曲线分析,^(1)H-MRS、3D-ASL、^(1)H-MRS联合3D-ASL技术在胶质瘤分级诊断中的敏感度分别为84.21%、78.95%、89.47%,特异度分别为89.47%、89.47%、94.74%,AUC值分别为0.868、0.842、0.921,约登指数分别为0.737、0.684、0.842。结论^(1)H-MRS参数值(Cho/Cr、Cho/NAA、Lac/Cr值)、3D-ASL(CBF值)可用于对胶质瘤进行分级诊断;联合应用^(1)H-MRS和3D-ASL对胶质瘤进行分级诊断,可优势互补,较单独应用3D-ASL或^(1)H-MRS具有更高的敏感度和特异度。

Objective To investigate the combination of magnetic resonance spectroscopy(^(1)H-MRS)and 3 D-arterial spin labeling(3 D-ASL)imaging in assessing the histologic grade of cerebral gliomas.Methods Thirty-eight pathologically confirmed glioma cases were selected,19 of whom were placed in the low grade glioma group and the remaining 19 were in the high grade group.All the patients then underwent^(1)H-MRS and 3 D-ASL scans.The original data were imported to a post processing application program to obtain a series of^(1)H-MRS metabolite ratios(NAA/Cr,Cho/Cr,Cho/NAA,MI/Cr,Lac/Cr)and the corresponding cerebral blood flow(CBF)maps.Subsequently,the parameters of ROI were measured and calculated for analysis by SPSS,Two sample independent t-test was conducted using SPSS version 19.0 and P<0.05 was considered as statistically significant.The diagnostic sensitivity,specificity and AUC of^(1)H-MRS,3 D-ASL and their combination were assessed through receiver operator characteristic(ROC)analysis.Results Cho/Cr,Cho/NAA,Lac/Cr and CBF in the high grade glioma group[(4.160±0.946),(4.362±1.070),(4.720±4.856),(84.733±15.133)mL/(min·100 g)]were significantly higher than those in the low grade glioma group[(2.074±0.401),(2.143±0.592),(0.925±0.525),(48.483±7.795)mL/(min·100 g)](P<0.05).NAA/Cr readings in the high grade glioma group(0.746±0.273)were lower than those in the low grade glioma group(0.907±0.262),but showed no statistically significant difference(P>0.05).Furthermore,MI/Cr in the high grade glioma group(0.377±0.191)were slightly higher than those in the low grade glioma group(0.359±0.178),showing no statistically significant difference(P>0.05).The ROC analysis showed that the sensitivity of^(1)H-MRS,3 D-ASL and the combination of them in the grading diagnosis of glioma were 84.21%,78.95%and 89.47%respectively,the specificity were 89.47%,89.47%and 94.74%,and the area under the curve(AUC)were 0.868,0.842 and 0.921 respectively.The youden index were 0.737,0.684 and 0.842 respectively.Conclusion This research showed that the parameters of^(1)H-MRS(Cho/Cr,Cho/NAA,Lac/Cr)and 3 D-ASL(CBF)could be used for grading diagnosis of glioma,of interests,the combination of^(1)H-MRS and 3 D-ASL offered higher sensitivity and specificity than each of them alone.