多体素氢质子MR波谱结合ADC鉴别胶质瘤复发与放射性坏死

摘要

Objective To explore the clinical application value of multi-voxel proton magnetic resonance spectroscopy (1 H-MRS) combined with ADC in differential diagnosis of glioma recurrence and radionecrosis. Methods We retrospectively ana-lysed 1H-MRS and ADC images of 38 patients after glioma surgery and radiotherapy with abnormal intensive signal on MR images from the our hospital. We measured choline(Cho)/creatine(Cr),Cho/N-acetylaspartate(NAA),NAA/Cr and ADC values of abnormal intensive signal area,edema and normal brain tissue and compared the differences of Cho/Cr,Cho/NAA,NAA/Cr and lesions-contra relative ADC (rADC) values between glioma recurrence and radionecrosis groups. ROC curve analysed the best di-agnostic boundary values of each parameter and the corresponding diagnostic sensitivity and specificity. Results All 17 patients were glioma recurrence and the rest of 21 cases were radionecrosis. The Cho/Cr,Cho/NAA of abnormal intensive signal area and edema in recurrence group were significantly higher than that in radionecrosis group ( P <0.05). The rADC of abnormal inten-sive signal area in recurrence group was lower than those in radionecrosis group( P <0.05). The best diagnosis cut off values of Cho/Cr and Cho/NAA and rADC in abnormal intensive signal area were 2.470,2.825 and 0.538. The best diagnosis cut off val-ues of Cho/Cr and Cho/NAA in edema were 1.345 and 1.750. Conclusion Clinic can jointly apply the multi-voxel 1H-MRS and ADC iamges to differentially diagnose glioma recurrence and radionecrosis, which could be benefit for timely selecting more reasonable individualized treatment project.%目的 探讨多体素氢质子MR波谱(1 H-MRS)联合ADC图鉴别胶质瘤术后放疗后复发与放射性坏死的临床应用价值.方法 回顾分析我院38例胶质瘤术后放疗后行MR检查发现异常强化病灶患者的1H-MRS和ADC图资料.测量强化区、水肿区以及正常脑组织区的胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天冬氨酸(NAA)、NAA/Cr及ADC值.比较复发与放射性坏死两组间Cho/Cr、Cho/NAA、NAA/Cr以及病灶-对侧相对ADC(rADC)值的差异.ROC曲线分析各参数值最佳诊断界值及对应的诊断敏感性、特异性.结果 胶质瘤术后复发17例,放射性坏死21例.复发组强化区、水肿区的Cho/Cr、Cho/NAA均明显高于放射性坏死组( P <0.05).复发组强化区rADC值低于放射性坏死组( P <0.05).强化区Cho/Cr、Cho/NAA、rADC值最佳诊断界值分别为2.470、2.825、0.538.水肿区Cho/Cr、Cho/NAA最佳诊断界值分别为1.345、1.750.结论 临床可联合应用多体素1H-MRS和ADC图对胶质瘤术后放疗后复发与放射性坏死进行鉴别诊断,从而有助于及时合理的选择个体化治疗方案.