摘要
目的探讨多体素氢质子MR波谱(1H-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(r ADC)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r ADC值低于放射性坏死组(P<0.05)。强化区Cho/Cr、Cho/NAA、r ADC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。
Objective To explore the clinical application value of multi-voxel proton magnetic resonance spectroscopy(1H-MRS)combined with ADC in differential diagnosis of glioma recurrence and radionecrosis.Methods We retrospectively analysed 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 diagnostic 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 intensive 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 values 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.
作者
卢玉花
赵华丽
张士玉
沈情
梁宗辉
LU Yuhua;ZHAO Huali;ZHANG Shiyu;SHEN Qing;LIANG Zonghui(Department of Radiology,Jing'an District Centre Hospital of Shanghai(Jing'an Branch,Affiliated Huashan Hospital of Fudan University),Jingan,Shanghai 200040,P.R.China)
出处
《医学影像学杂志》
2018年第4期529-532,共4页
Journal of Medical Imaging
基金
上海市静安区卫生系统人才培养计划项目(编号:JWRC2014D04)
上海市静安区卫生计生系统科研课题项目(编号:JWRC2014Q04)
关键词
脑胶质瘤
磁共振成像
氢质子磁共振波谱
复发
放射性坏死
Glioma
Magnetic resonance imaging
Proton magnetic resonance spectroscopy
Recurrence
Radionecrosis
作者简介
卢玉花(1982-),女,江苏扬州人,毕业于蚌埠医学院,本科,主治医师,主要从事医学影像学诊断及神经功能影像研究工作。;通信作者:梁宗辉,主任医师,E-mail:liangzh@vip.163.com
