多体素^(1)H-MRS及DWI对脑高级别胶质瘤与转移瘤的鉴别诊断

Differentiation of brain high grade gliomas from metastases using multi-voxel ^(1)H-magnetic resonance spectroscopy and diffusion-weight imaging

目的评估多体素^(1)H-MRS、DWI对胶质母细胞瘤(GBM)、间变性星形细胞瘤(AA)与转移瘤的鉴别诊断价值。方法回顾性分析2018年5月~2023年3月本院经病理证实的33例GBM、16例AA,17例脑转移瘤患者的临床资料,术前3.0T MRI行常规MRI、MRS、DWI检查。MRS图中测量瘤体区、瘤周区的MRS主要代谢产物比值最大Cho/NAA、最大Cho/Cr及最小NAA/Cr值。结合DWI图,选择ADC图中低信号区域测量瘤体、瘤周ADCmin,并测量对侧正常脑白质区域的ADCmin,计算rADCmin。运用独立t检验,Whitney-U检验评估GBM、AA与转移瘤之间的Cho/NAA、Cho/Cr、NAA/Cr、ADCmin及rADCmin差异。ROC曲线分析MRS及DWI参数的鉴别诊断效能。P<0.05表示差异有统计学意义。结果GBM、AA瘤体Cho/NAA值大于转移瘤,瘤体NAA/Cr小于转移瘤(P<0.05),两者均可实现鉴别诊断价值,以对AA与转移瘤之间的鉴别诊断效能最优,相应AUC为0.838,0.852,敏感性、特异性分别为80.00%,73.33%,75.00%,87.50%.DWI定量参数ADCmin、rADCmin均不能实现对GBM、AA与转移瘤的鉴别(P>0.05)。结论多体素^(1)H-MRS是鉴别诊断GBM、AA与转移瘤的有效影像学方法,而DWI的鉴别诊断价值有限。

Objective To assess the contribution of multi-voxel ^(1)H-magnetic resonance spectroscopy(^(1)H-MRS)and diffusion-weight imaging(DWI)in differentiating glioblastoma multiforme(GBM)and anaplastic astrocytoma(AA)from metastases.Methods Brain tumors including 33 GBMs,16 AAs and 17 metastases before treatment performed on conventional MRI,^(1)H-MRS and DWI were retrospectively analyzed.Metabolite ratios including maximum Cho/NAA,maximum Cho/Cr,minimum NAA/Cr,and minimum apparent diffusion coefficient(ADCmin)were recorded in intratumoral and peritumoral regions.ADCmin of normal white matter was measured to obtain the relative minimum ADC(rADCmin).The differences of Cho/NAA,Cho/Cr,NAA/Cr,ADCmin and rADCmin between GBM,AA and metastases were evaluated respectively by Student t-test or Mann-Whitney U-test,and the diagnostic performance was evaluated by ROC curve analysis.Results Both GBM and AA showed higher intratumoral Cho/NAA,but lower NAA/Cr values than metastases with significant differences(P<0.05).Both intratumoral Cho/NAA and NAA/Cr demonstrated significant diagnostic performance in differentiating GBM and AA from metastases,especially for differentiating AA from metastases,showing area under curve(AUC)of 0.838 and 0.852,sensitivity of 80.00%and 73.33%,specificity of 75.00%and 87.50%.However,the intratumoral or peritumoral ADCmin and rADCmin showed limited diagnostic performance in discriminating GBM or AA from metastasis(P>0.05).Conclusion Multi-voxel ^(1)H-MRS shows effective diagnosis in differentiating GBM and AA from metastasis.However,the differential diagnostic effectiveness of DWI is limited.