多模态MRI在颅脑肿瘤患者诊治中的应用

目的分析多模态磁共振成像(MRI)在颅脑肿瘤诊治中的应用价值。方法回顾性分析2017年1月至2019年4月于我院接受诊疗且经术后病理证实的62例颅脑肿瘤患者的临床资料,患者术前均有常规MRI检查及多模态MRI检查弥散加权成像(DWI)、三维动脉自旋标记(3D-ASL)、氢质子磁共振波谱(~1H-MRS)],分析DWI弥散图中瘤体和对侧镜像区表观弥散系数(ADC)、相对表观弥散系数(rADC),3D-ASL灌注图中最大肿瘤血流量(TBF)及对侧镜像区、对侧正常白质及灰质脑血流量(CBF)值,~1H-MRS波谱图中瘤体、瘤周及正常脑实质感兴趣区(ROI)的胆碱(Cho)、肌酸(Cr)、N-乙酰天门冬氨酸(NAA)代谢物峰值及相互比值,比较常规MRI与联合多模态MRI对颅脑肿瘤的诊断符合率。结果DWI弥散图显示,高级别胶质瘤、脑膜瘤、转移瘤瘤体ADC值及rADC值均显著低于低级别胶质瘤(P<0.05);3D-ASL灌注图显示,低级别胶质瘤灌注值显著低于高级别胶质瘤、脑膜瘤及转移瘤(P<0.05);~1H-MRS波谱图显示,胶质瘤、脑膜瘤、转移瘤瘤体、瘤周Cho/Cr、Cho/NAA均显著高于正常脑实质(P<0.05),且胶质瘤瘤周Cho/Cr、Cho/NAA值显著高于脑膜瘤、转移瘤(P<0.05);脑膜瘤瘤体Cho/NAA值显著高于胶质瘤、转移瘤(P<0.05),NAA/Cr值显著低于胶质瘤、转移瘤(P<0.05);联合多模态MRI诊断符合率96.77%显著高于单纯常规MRI检查的83.87%(P<0.05)。结论DWI对颅脑肿瘤鉴别、3D-ASL对胶质瘤分级、~1H-MRS对肿瘤边界确定有积极意义,在常规MRI检查基础上联合多模态MRI检查,能提高颅脑肿瘤诊断符合率。

Application of Multimodal MRI in the Diagnosis and Treatment of Patients with Brain Tumors

Objective To analyze the application value of multimodal magnetic resonance imaging(MRI)in the diagnosis and treatment of brain tumors.Methods The clinical data of 62 patients with brain tumors treated in the hospital from January 2017 to April 2019 and were confirmed by postoperative pathology were retrospectively analyzed.Patients underwent routine MRI and multimodal MRI before surgerydiffusion weighted imaging(DWI),three-dimensional a rterial spin labeling(3D-ASL),H magnetic resonance spectroscopy(~1H-MRS)],and the apparent diffusion coefficient(ADC)and relative apparent diffusion coefficient(rADC)of the tumor and contralateral mirror area in DWI diffusion ma p,maximum tumor blood flow(TBF)and cerebral blood flow(CBF)values of contralateral mirror area,contralateral normal white matter and gray matter in 3D-ASL perfusion map and peak values and mutual ratios of choline(Cho),creatine(Cr)and N-a cetyl aspartate(NAA)metabolites in the tumor,peri-tumor and normal brain parenchymal regions of interest(ROI)in~1H-MRS spectrum were analyzed.The diagnostic coincidence rate of conventional MRI and combined multimodal MRI on brain tumors were compared.Results DWI diffusion map showed that the ADC values and rADC values of high-grade gliomas,meningiomas and metastatic tumors were significantly lower than those of low-grade gliomas(P<0.05).3D-ASL perfusion map showed that the perfusion value of low-grade gliomas was su bstantially lower than that of high-grade gliomas,meningiomas and metastatic tumors(P<0.05).~1H-MRS spectroscopy showed that the Cho/Cr and Cho/NAA of gliomas,meningiomas,metastatic tumors,and peri-tumor were significantly higher than those of normal brain parenchyma(P<0.05),and the Cho/Cr and Cho/NAA of glioma peri-tumor were significantly higher than those of meningiomas and metastatic tumors(P<0.05).The Cho/NAA of meningiomas was significantly higher than that of gliomas and metastatic tumors(P<0.05),and the NAA/Cr was significantly lower than that of gliomas and metastatic tumors(P<0.05).The diagnostic coincidence rate of combined multimodal MRI was significantly higher than that of conventional MRI(96.77%vs 83.87%)(P<0.05).Conclusion DWI has positive effects on identifying brain tumors,3D-ASL on glioma grade,and~1H-MRS on tumor boundary determination.Combined multimodal MRI based on routine MRI examination can improve the diagnostic coincidence rate of brain tumors.