摘要
目的探讨磁共振动态对比增强成像(DCE-MRI)联合磁共振波谱分析(NMRS)在脑肿瘤诊断中的应用价值。方法回顾性收集2018年4月至2024年6月至解放军总医院第九医学中心手术治疗的120例脑肿瘤患者临床资料,依据术后病理诊断结果分为脑恶性肿瘤组(n=76,包括胶质瘤71例、脑转移瘤5例)和脑良性肿瘤组(n=44,包括脑膜瘤24例、垂体腺瘤11例、听神经瘤9例);依据WHO分级,将71例脑胶质瘤患者进一步分为Ⅰ-Ⅱ级(n=31)和Ⅲ-Ⅳ级(n=40)两组。统计所有患者术前DCE-MRI检查参数[容量转运参数(Ktrans)、速率常数(Kep)及血管外细胞外间隙容积比(Ve)]及NMRS检查参数[N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr),计算NAA/Cho、Cho/Cr及NAA/Cr值],探讨DCE-MRI联合NMRS在脑肿瘤良恶性及胶质瘤分级中的应用价值。结果脑恶性肿瘤组K^(trans)、K_(ep)、V_(e)、Cho/Cr大于脑良性肿瘤组,NAA/Cho、NAA/Cr小于脑良性肿瘤组,差异有统计学意义(P<0.05)。绘制受试者工作特征曲线(ROC曲线),提示DCEMRI参数(K^(trans)、K_(ep)、V_(e))、NMRS检查参数(NAA/Cho、Cho/Cr、NAA/Cr)单独及联合诊断脑肿瘤良恶性的曲线下面积(AUC)值分别为0.622、0.624、0.648、0.732、0.696、0.635、0.855,DCE-MRI联合NMRS诊断脑肿瘤良恶性价值最高(P<0.05)。胶质瘤Ⅲ-Ⅳ组K^(trans)、K_(ep)、V_(e)、Cho/Cr大于胶质瘤Ⅰ-Ⅱ级组,NAA/Cho、NAA/Cr小于胶质瘤Ⅰ-Ⅱ级组,差异有统计学意义(P<0.05)。相关性分析显示,DCE-MRI、NMRS检查参数与胶质瘤不同分级间存在相关性(P<0.05)。结论DCE-MRI联合NMRS在诊断脑肿瘤良恶性中应用价值较高,且可辅助胶质瘤分级诊断。
Objective To explore the application value of dynamic contrast enhanced-magnetic resonance imaging(DCE-MRI)combined with magnetic resonance spectroscopy(NMRS)in the diagnosis of brain tumors.Methods The clinical data of 120 patients with brain tumors who underwent surgical treatment in the Ninth Medical Center of Chinese PLA General Hospital from April 2018 to June 2024 were retrospectively collected.According to the results of postoperative pathological diagnosis,they were divided into malignant brain tumor group(n=76,including 71 cases of glioma and 5 cases of brain metastasis)and benign brain tumor group(n=44,including 24 cases of meningioma,11 cases of pituitary adenoma and 9 cases of acoustic neuroma).According to WHO classification,71 patients with glioma were further divided into two groups:grade Ⅰ-Ⅱ(n=31)and grade Ⅲ-Ⅳ(n=40).Preoperative DCE-MRI examination parameters[volume transport parameter(K^(trans)),rate constant(K_(ep)),extracellular space volume ratio(V_(e))]and NMRS examination parameters(N-acetylaspartate(NAA),choline compound(Cho),creatine(Cr))of all patients were analyzed.[NAA/Cho,Cho/Cr and NAA/Cr values were calculated]to explore the application value of DCE-MRI combined with NMRS in the classification of benign and malignant brain tumors and glioma.Results K^(trans),K_(ep),V_(e),Cho/Cr in the brain malignant tumor group were higher than those in the brain benign tumor group,while NAA/Cho and NAA/Cr were lower than those in the brain benign tumor group,with statistical significant differences(P<0.05).Receiver operating characteristic curves(ROC curves)were drawn to indicate that the area under the curve(AUC)values for DCE-MRI parameters(K^(trans),K_(ep),V_(e))and NMRS examination parameters(NAA/Cho,Cho/Cr,NAA/Cr)alone and in combination for diagnosing benign and malignant brain tumors were 0.622,0.624,0.648,0.732,0.696,0.635,and 0.855,respectively.DCE-MRI combined with NMRS had the highest diagnostic value for benign and malignant brain tumors(P<0.05).K^(trans),K_(ep),V_(e),Cho/Cr in glioma group Ⅲ-Ⅳ were higher than those in glioma grade Ⅰ-Ⅱ group,while NAA/Cho and NAA/Cr were lower than those in glioma grade Ⅰ-Ⅱ group,with statistical significant differences(P<0.05).Correlation analysis showed that there was a correlation between DCE-MRI,NMRS examination parameters and different grades of glioma(P<0.05).Conclusion DCE-MRI combined with NMRS has high application value in the diagnosis of benign and malignant brain tumors,and can assist in the grading diagnosis of gliomas.
作者
周秀秀
曾亚伟
郑冬
ZHOU Xiu-xiu;ZENG Ya-wei;ZHENG Dong(Department of Diagnostic Radiology,the Ninth Medical Center,Chinese PLA General Hospital,Beijing 100000,China)
出处
《中国CT和MRI杂志》
2025年第10期8-11,共4页
Chinese Journal of CT and MRI
关键词
脑肿瘤
胶质瘤
磁共振动态对比增强成像
磁共振波谱分析
诊断
Brain Tumor
Glioma
Dynamic Contrast Enhanced-magnetic Resonance Imaging
Nuclear Magnetic Resonance Spectroscopy Analysis
Diagnosis
