MRI多体素1H-MRS联合DWI和DCE对舌鳞状细胞癌的诊断价值

目的: 探讨联合运用磁共振¹H-MRS、DWI和DCE对舌鳞状细胞癌诊断价值。方法: 回顾分析2016年6月—2017年10月间经手术病理证实的舌鳞状细胞癌患者45例（实验组）和无症状志愿者25例,2组均行常规MR、¹H-MRS、DWI和DCE检查。比较实验组肿瘤实体区与对照组¹H-MRS代谢产物（Cho、Cr、Cho/Cr比值、LL）的区别;实验组肿瘤实体区与近肿瘤区、远肿瘤区域带内ADC值均数、DCE最大斜率均数的差别以及不同区域带内TIC曲线类型的差异;实验组肿瘤实体区同一部位LL信号强度与ADC值、DCE最大斜率之间的相互关系,并比较三者在肿瘤边界诊断中的价值。采用SPSS 22.0软件包进行独立样本t检验、配对t检验和χ²检验。结果: 舌鳞状细胞癌肿瘤实体区内¹H-MRS代谢产物Cho、LL信号强度较对照组显著升高（P<0.01）;肿瘤实体区、近肿瘤区、远肿瘤区内ADC值、DCE最大斜率均数两两比较均有显著差异（P<0.01）;不同区域间TIC曲线类型分布有显著性差异（P<0.01）;肿瘤实体区内LL信号分布与ADC值呈线性负相关,与DCE最大斜率呈线性正相关（P<0.01）。多体素¹H-MRS联合DWI、DCE成像能获取近肿瘤区较高的诊断准确率。结论: MRI多体素¹H-MRS成像可以无创在体反映肿瘤代谢产物;结合DWI、DCE成像,能为手术判定舌癌边界区域提供有价值的客观依据。

Value of multi-voxel 1H-MRS combined with DWI and DCE in diagnosis of squamous cell carcinoma of tongue

PURPOSE: To explore the value of multi-voxel ¹H-MRS with DWI and DCE in clinical diagnosis of squamous cell carcinoma (SCC) of the tongue. METHODS: A group of 45 cases that were pathologically determined with SCC and a control group of 25 cases, from June 2016 to October 2017, were selected for retrospective analysis. Both groups underwent routine MR, ¹H-MRS, DWI and DCE examinations. We compared the metabolites of ¹H-MRS (Cho,Cr,Cho/Cr ratio and LL), the variation of ADC value, maximum DCE slope and TIC curve type in focus, relative and distant areas of the SCC, and investigated the relationship of LL peak to ADC value and the maximum DCE slope, as well as its value in diagnosis of SCC. The parameters were analyzed with SPSS 22.0 software package for independent sample t test, paired t test and Chi-square test. RESULTS: The patients group showed significantly higher Cho and LL signals than the control group (P<0.01). The ADC value, maximum DCE slope and TIC curve type were significantly different in focus, relative and distant areas of SCC (P<0.01). The LL signal in the focus SCC area showed inverse linear correlation to ADC value (P<0.01), whereas it was linearly correlated to the maximum DCE slope (P<0.01). Multi-voxel ¹H-MRS combined with DWI and DCE improved the diagnostic accuracy of SCC of the tongue. CONCLUSIONS: Multi-voxel ¹H-MRS is a noninvasive method to acquire metabolic signals of SCC. It offers reliable and valuable approach to diagnose SCC of the tongue when combined with DWI and DCE imaging.