^(1)H-MRS对间变性星形细胞瘤与原发性中枢神经系统淋巴瘤的鉴别诊断价值

Diagnostic value of ^(1)H-MRS for discriminating anaplastic astrocytoma and primary CNS lymphomas

目的探讨氢质子磁共振波谱(^(1)H-magnetic resonance spectroscopy,^(1)H-MRS)技术在间变性星形细胞瘤(Anaplastic astrocytoma,AA)与原发性中枢神经系统淋巴瘤(Primary CNS lymphomas,PCNSL)鉴别诊断中的价值。方法选取并分析42例经手术病理证实的AA和PCNSL患者的相关影像与临床资料,其中AA24例(AA组)、PCNSL18例(PCNSL组)。影像资料包括MRI常规平扫加增强及^(1)H-MRS扫描图像。^(1)H-MRS检测颅脑乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)及脂质(Lip)峰的峰值,并计算Cho/NAA、Cho/Cr比值及NAA病灶/NAA健侧、Cho病灶/Cho健侧、Cr病灶/Cr健侧及(Lac+Lip)病灶/(Lac+Lip)健侧比值,使用SPSS 26.0统计软件,根据数据类型选用Student’s非配对t检验和Wilcoxon符号秩检验,以病理结果为金标准,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC)及敏感性、特异性指标。结果AA组多表现病灶Cho峰升高,NAA峰略降低。PCNSL组多表现病灶Cho峰升高,NAA峰降低,Lip峰升高。Cho/NAA、NAA病灶/NAA健侧及(Lac+Lip)病灶/(Lac+Lip)健侧值在2组间差异有统计学意义(P<0.05),(Lac+Lip)病灶/(Lac+Lip)健侧对区分两种疾病的敏感性为89.5%、特异性为90.3%。结论^(1)H-MRS对AA和PCNSL具有较好的诊断鉴别价值,其中(Lac+Lip)病灶/(Lac+Lip)健侧值对区分两者具有较高的敏感性和特异性。

Objective To evaluate the value of ^(1)H-MRS for discriminating anaplastic astrocytoma(AA)and primary CNS lymphomas(PCNSL).Methods The clinical data and imaging data of 42 patients with pathologically proven AA and PCNSL were retrospectively analyzed,including 24 AA patients(AA group)and 18 PCNSL patients(PCNSL group).All the patients underwent conventional MRI examinations(plain and enhanced imaging)and ^(1)H-MRS scan before surgery or treatment.After ^(1)H-MRS scan,the data were automatically transferred to workstation for standardized post-processing and the peak values of acetylaspartate(NAA),choline(Cho),creatine(Cr),lactate(Lac)and lipid(Lip)were detected in the focal area and contralateral brain area of the two groups.The ratios of the peak value of Cho to that of NAA(Cho/NAA)and to that of Cr(Cho/Cr)were calculated in the foci.The ratios of the peak values of NAA,Cho,Cr and(Lac+Lip)in the foci to those in the intact side(NAAF/NAAI,ChoF/ChoI,CrF/CrI,and(Lac+Lip)F/(Lac+Lip)I)were computed respectively.SPSS 26.0 statistical software,student's unpaired t-test and Wilcoxon signed rank test were selected according to the data type.Taking the pathological results as the gold standard,the receiver operating characteristic curve(ROC)was drawn,the area under the curve(AUC),sensitivity and specificity indexes were calculated.Results AA group showed increased Cho and decreased NAA in the focal area,and the PCNSL group had raised Cho and Lip,and lower NAA in the focal area.There were statistical differences between the two groups in Cho/NAA,NAAF/NAAI and(Lac+Lip)F/(Lac+Lip)(P<0.05).The sensitivity and specificity of(Lac+Lip)F/(Lac+Lip)I)ratio for discriminating AA from PCNSL were 89.5%and 90.3%respectively.Conclusion ^(1)H-MRS is helpful for differentiating PCNSL from AA,and(Lac+Lip)F/(Lac+Lip)I ratio maybe has higher diagnostic value for differentiating the two diseases.