多模态磁共振成像技术在胶质瘤评价中的应用研究

目的探讨多模态MRI在脑胶质瘤诊断、分级中的应用价值。材料与方法对30例胶质瘤患者的MRI平扫、增强以及功能MRI图像进行分析,对比高、低级别组肿瘤强化方式、瘤周水肿程度、扩散加权成像(diffusion weighted imaging,DWI)信号强度、磁敏感加权成像(susceptibility weighted imaging,SWI)中肿瘤内磁敏感性信号(intratumoral susceptibility signal intensity,ITSS)分级、动脉自旋标记(arterial spin labeling,ASL)灌注以及扩散张量纤维束成像(diffusion tensor tractography,DTT)图中纤维束状态的差异。测定扩散张量成像(diffusion tensor imaging,DTI)中部分各向异性(fractional anisotropy,FA)值、表观扩散系数(apparent diffusion coefficient,ADC)值以及1H磁共振波谱成像(MR spectroscopy,MRS)中胆碱(choline,Cho)/肌酸(creatine,Cr)、N-乙酰天门冬氨酸(N-acetyl aspartic acid,NAA)/Cr和Cho/NAA比值,并进行统计学分析。结果共30例患者中高级别15例,低级别15例。高、低级别组间,强化方式及DWI信号差异无统计学意义(P0.05),水肿程度差异具有统计学意义(P0.05),三者联合分级诊断曲线下面积(area under curve,AUC)为0.796。12例患者行DTI、ASL、SWI和1H-MRS检查。ASL灌注、DTT纤维束状态间差异有统计学意义(P0.05),SWI中ITSS分级无统计学差异(P0.05),AUC分别为0.889、0.833、0.778。高、低级别组间ADC值以及~1H-MRS代谢物比值Cho/Cr、NAA/Cr和Cho/NAA差异有统计学意义(P0.05),FA值差异无统计学意义(P0.05),AUC分别为0.972、0.972、1.000、1.000、0.486。结论多模态MR成像技术在脑胶质瘤诊断、分级中提供更多有效信息。

Application of multimodal magnetic resonance imaging in the evaluation of gliomas

Objective: To investigate the application of multimodal magnetic resonance imaging in the diagnosis and grading of gliomas. Materials and Methods:Thirty patients of glioma with pathological and immune-histochemical confirmation, who underwent conventional and functional MRI were retrospectively enrolled in the study. Tumor enhancement, peritumoral edema, signal intensity of diffusion weighted imaging (DWI), intratumoral susceptibility signal intensity (ITSS) in susceptibility weighted imaging (SWI), perfusion in arterial spin labeling (ASL) and state of fiber bundles were compared in high grade gliomas and low grade gliomas. Fractional anisotropy (FA) value and apparent diffusion coefficient (ADC) value in diffusion tensor imaging (DTI) as well as choline (Cho) /creatine (Cr), N-acetyl aspartic acid (NAA)/Cr and Cho/NAA in 1H MR spectroscopy (MRS) were measured and calculated. The differences of all the above indexes in the two groups were statistically analyzed. Results: There were 15 HGG and 15 LGG. Peritumoral edema, ASL perfusion, fiber bundles state, ADC value and Cho/Cr, NAA/Cr, Cho/NAA between the two groups were significantly different (P<0.05). Tumor enhancement, DWI signal intensity, ITSS and FA value were not significantly different (P>0.05). The area under curve (AUC) of ASL perfusion, fiber bundle status, ITSS, ADC, Cho/Cr, NAA/Cr, Cho/NAA and FA were 0.889, 0.833, 0.778, 0.972, 0.972, 1.000, 1.000 and 0.486, respectively. The combined AUC of peritumoral edema, tumor enhancement and DWI signal intensity was 0.796. Conclusions: Multimodal MRI can provide comprehensive information of glioma, which plays a significant role in accurate diagnosis.