多模式fMRI应用于脑胶质瘤术后复发诊断中的价值及对放化疗的指导意义

The value of multimodal magnetic resonance functional imaging in the diagnosis of postoperative glioma recurrence and its implications for radiotherapy

目的探究多模式fMRI诊断脑胶质瘤术后复发及指导放化疗的价值。方法选取我院行术后放化疗的脑胶质瘤患者60例的临床资料。比较术后复发30例(复发组)和假性进展(PsP)30例(PsP组)一般资料、脑脊液外泌体复发相关标志物[微小RNA-146a(miR-146a)、微小RNA-424(miR-424)]、多模式fMRI参数[标准化脑血容量(CBV‐_(norm))、ADC、代谢物胆碱(Cho)与肌酸/磷酸肌酸(Cr)比值(Cho/Cr)、Cho与N-乙酰天门冬氨酸(NAA)比值(Cho/NAA)]。分析脑胶质瘤患者多模式fMRI参数与脑脊液外泌体miR-146a、miR-424的相关性、诊断脑胶质瘤术后复发的价值。结果复发组平均CBV_(norm)、最大CBV_(norm)、Cho/Cr、Cho/NAA及脑脊液外泌体miR-424相对表达量均高于PsP组,ADC、脑脊液外泌体miR-146a相对表达量低于PsP组,差异有统计学意义(P<0.05);脑胶质瘤患者术后fMRI参数平均CBV_(norm)、最大CBV_(norm)、Cho/Cr、Cho/NAA与脑脊液外泌体miR-146a相对表达量呈负相关,与miR-424相对表达量呈正相关,ADC与miR-146a相对表达量呈正相关,与miR-424相对表达量呈负相关(P<0.05);平均CBV_(norm)、最大CBV_(norm)、ADC、Cho/Cr、Cho/NAA、脑脊液外泌体miR-146a、miR-424相对表达量诊断脑胶质瘤术后复发的曲线下面积(AUC)分别为0.733、0.829、0.749、0.779、0.810、0.719、0.707;平均CBV_(norm)、最大CBV_(norm)、ADC、Cho/Cr、Cho/NAA联合诊断术后复发的AUC为0.932(95%CI为0.837~0.981),诊断敏感度、特异度分别为90.00%、90.00%。结论多模式fMRI在鉴别诊断脑胶质瘤术后复发和PsP方面具有可靠诊断效能,可指导临床脑胶质瘤术后放化疗方案的制定。

Objective To investigate the value of multimodal magnetic resonance functional imaging in diagnosing postopera⁃tive recurrence of glioma and guiding radiotherapy.Methods The clinical data of 60 patients with glioma who underwent post⁃operative radiotherapy in our hospital were selected.General information,cerebrospinal fluid exocytosis recurrence-related mark⁃ers[microRNA-146a(miR-146a),microRNA-424(miR-424)],multimodal fMRI parameters[standardized cerebral blood vol⁃ume(CBV_(norm)),ADC,metabolite choline(Cho)to creatine/phosphocreatine(Cr)ratio(Cho/Cr),and Cho to Nacetylaspartate(NAA)ratio(Cho/NAA)]were compared.The correlation of multimodal fMRI parameters with cerebrospinal fluid exosomes miR-146a and miR-424 in patients with glioma,as well as the value of diagnosing postoperative recurrence of glioma were analyzed.Results The mean CBV_(norm),maximum CBV_(norm),Cho/Cr,Cho/NAA and cerebrospinal fluid exosome miR-424 relative expressions were higher in the recurrence group than in the PsP group,and the ADC and cerebrospinal fluid exosome miR-146a relative expressions were lower than those in the PsP group(P<0.05);the mean postoperative magnetic resonance functional imaging parameters in patients with glioma CBV_(norm),maximal CBV_(norm),Cho/Cr,and Cho/NAA were nega⁃tively correlated with the relative expression of cerebrospinal fluid exosome miR-146a and positively correlated with miR-424,and ADC was positively correlated with the relative expression of miR-146a and negatively correlated with miR-424(P<0.05).The area under the curve(AUC)for the diagnosis of postoperative recurrence of glioma for mean CBV_(norm),maximum CBV_(norm),ADC,Cho/Cr,Cho/NAA,cerebrospinal fluid exosome miR-146a,and miR-424 relative expression was 0.733,0.829,0.749,0.779,0.810,0.719,and 0.707,respectively,and the maximum AUC for the combined diagnosis of mean CBV_(norm),maximum CBV_(norm),ADC,Cho/Cr,and Cho/NAA for postoperative recurrence was 0.932(95%CI 0.837-0.981),with diagnostic sensi⁃tivity and specificity of 90.00%and 90.00%,respectively.Conclusion Multimodal magnetic resonance functional imaging has reliable diagnostic efficacy in the differential diagnosis of postoperative glioma recurrence and PsP,which can guide the develop⁃ment of clinical postoperative radiotherapy regimens for glioma.