Prediction of peritumoral invasion of high grade gliomas by diffusion tensor imaging and 1H MRS
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摘要:
目的 研究弥散张量成像（DTI）、氢质子磁共振波谱（1H MRS）影像表现对颅脑胶质瘤的鉴别诊断及对高级别胶质瘤瘤周浸润的预测价值。 方法 采取前瞻性研究，以2017年2月~2020年1月在我院进行治疗的69例颅脑胶质瘤患者作为研究对象，根据世界卫生组织2007年中枢神经系统肿瘤的病理分期情况分析，低级别胶质瘤患者36例，高级别胶质瘤患者33例，比较两组患者的DTI、1H MRS影像表现差异，分析DTI、1H MRS联合诊断对高级别胶质瘤瘤周浸润的诊断价值。 结果 低级别胶质瘤患者的ADC显著高于高级别胶质瘤（t=4.480，P < 0.001）；在肿瘤组织中，低级别胶质瘤患者的NAA/Cr（t=8.477，P < 0.001）、Cho/ Cr（t=5.851，P < 0.001）、Lip+Lac/Cr（t=19.141，P < 0.001）低于高级别胶质瘤患者，Cho/NAA（t=2.493，P=0.015）高于高级别胶质瘤患者；在瘤周组织中，低级别胶质瘤患者的NAA/Cr（t=2.503，P=0.015）低于高级别胶质瘤患者，Cho/NAA（t=6.937，P < 0.001）、Cho/Cr（t=14.267，P < 0.001）、Lip+Lac/Cr（t=2.322，P=0.023）高于高级别胶质瘤患者；DTI、1H MRS联合诊断对高级别胶质瘤患者的诊断灵敏度显著高于单独检测。 结论 DTI、1H MRS影像表现对颅脑胶质瘤的鉴别诊断及对高级别胶质瘤瘤周浸润的预测效能较高，建议临床推广。 Abstract:Objective To explore the value of diffusion tensor imaging (DTI) and 1H MRS in the differential diagnosis of brain gliomas and in the prediction of peritumoral invasion of high-grade gliomas. Methods In this prospective study, 69 patients with brain glioma who were treated in our hospital from February 2017 to January 2020 were selected. According to the pathological staging of central nervous system tumor of who in 2007, there were 36 patients with low-grade glioma and 33 patients with high-grade glioma. The DTI and 1H of the two groups were compared to analyze the diagnostic value of DTI and 1H MRS in the diagnosis of peritumoral infiltration of high-grade gliomas. Result ADC of low-grade gliomas was significantly higher than that of high-grade gliomas (t=4.480, P < 0.001). NAA/Cr (t=8.477, P < 0.001), CHO/Cr (t=5.851, P < 0.001) and Lip + Lac/ Cr (t=19.141, P < 0.001) of low-grade gliomas were significantly lower than those of high-grade gliomas. CHO/NAA (t=2.493, P= 0.015) of low-grade gliomas were significantly higher than those of high-grade gliomas In tissues. NAA/Cr (t=2.503, P=0.015) of low-grade glioma patients was significantly lower than that of high-grade glioma patients, CHO/NAA (t=6.937, P < 0.001), CHO/ Cr (t=14.267, P < 0.001) and lip + Lac/Cr (t=2.322, P=0.023) of low-grade glioma patients were significantly higher than that of high-grade glioma patients; the diagnostic sensitivity of DTI and 1H MRS combined diagnosis was significantly higher than that of single detection. Conclusion DTI, 1H MRS imaging performance of brain glioma in the differential diagnosis and high-grade glioma peritumoral infiltration of high-grade predictive efficiency, it is recommended that clinical promotion. -
Key words:
- diffusion tensor imaging /
- 1H MRS /
- glioma /
- differential diagnosis
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图 1 两组患者的DTI影像学结果比较
A：低级别胶质瘤增强扫描。颅脑MRI增强扫描示右侧额叶病灶明显强化，累及皮层及皮层下结构，轮廓不整，中心局部见小囊状无强化影；B：低级别胶质瘤ADC. 病灶ADC图信号无明显降低，或者说扩散不受限；C：高级别胶质瘤增强扫描. 颅脑MRI增强扫描示胼胝体压部病变不均匀明显强化，中心囊变、坏死区无强化，病变边界欠清晰；D：高级别胶质瘤ADC. 病灶ADC图信号明显降低，或者说扩散受限；E：FA图，测量FA值，病变区FA值较正常镜像区稍减低；F：1H MRS图，上图谱线正常，下图谱线显示Ch峰轻度升高，Ch/Cr比值轻度升高，提示肿瘤性病变；G：FA图，测量FA值，病变区FA值明显降低；H：1H MRS图，上图谱线为病变谱线图，Ch峰明显升高，Ch/Cr比值升高，高度提示肿瘤；下图为正常图.
Figure 1. Comparison of DTI imaging results between the two groups.
表 1 两组患者的一般资料比较
Table 1. Comparison of general data between the two groups
组别 性别（n, 男/女） BMI（kg/m2, Mean±SD） 年龄（岁, Mean±SD） 肿瘤部位（额叶/颞叶/顶叶） 低级别胶质瘤（n=36） 16/20 24.23±2.12 38.22±1.22 14/15/7 高级别胶质瘤（n=33） 19/14 24.30±1.97 38.32±2.33 12/15/6 χ2/t 1.192 0.142 0.220 0.102 P 0.276 0.887 0.826 0.951 
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表 2 两组患者肿瘤组织的1H MRS影像学结果比较
Table 2. Comparison of 1H MRS imaging results of tumor tissue between the two groups (Mean±SD)
组别 NAA/Cr Cho/Cr Cho/NAA Lip+Lac/Cr 低级别胶质瘤（n=36） 1.17±0.24 3.14±0.97 3.04±0.26 3.31±0.61 高级别胶质瘤（n=33） 1.61±0.19 4.53±1.00 2.75±0.62 7.14±0.99 t 8.477 5.851 2.493 19.141 P < 0.001 < 0.001 0.015 < 0.001 NAA: N-乙酰天门冬氨酸; Cr: 肌酐; Cho: 胆碱; Lip: 脂质; Lac: 乳酸.
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表 3 两组患者瘤周组织的1H MRS影像学结果比较
Table 3. Comparison of 1H MRS imaging results of peritumoral tissues between the two groups (Mean±SD)
组别 NAA/Cr Cho/Cr Cho/NAA Lip+Lac/Cr 低级别胶质瘤（n=36） 1.42±0.64 1.68±0.15 1.27±0.09 0.66±0.26 高级别胶质瘤（n=33） 1.92±0.97 1.30±0.28 0.66±0.23 0.55±0.11 t 2.503 6.937 14.267 2.322 P 0.015 < 0.001 < 0.001 0.023
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表 4 联合诊断效能比较
Table 4. Comparison of joint diagnostic efficacy
诊断方法 真阳例数（n） 假阳例数（n） 真阴例数（n） 假阴例数（n） 准确率（%） 敏感度（%） 特异性（%） 阳性预测值（%） 阴性预测值（%） 1H MRS 30 15 21 3 73.91 90.91 41.18 66.67 87.50 DTI 31 17 19 2 72.46 93.94 38.00 64.58 90.48 联合诊断 32 22 14 1 66.67 96.97 30.43 59.26 93.33
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