摘要
目的 探讨活体^1HMR波谱（MRS）、脑灌注成像（PI）及扩散成像（DWI）对弥漫性星形细胞肿瘤的分级价值。方法 搜集经手术病理证实的弥漫性星形细胞肿瘤154例。按世界卫生组织分级：星形细胞瘤（Ⅱ级），间变型星形细胞瘤（Ⅲ级）以及胶质母细胞瘤（Ⅳ级）。35例行^1HMRS检查，其中Ⅱ级8例，Ⅲ级13例，Ⅳ级14例，比较各级肿瘤之间胆碱／肌酸（Cho／Cr）、N-乙酰天冬氨酸（NAA）／Cr及乳酸（Lac）／Cr值；76例应用MR平面回波成像技术（EPI）行对比剂增强灌注成像（CEPI），包括Ⅱ级36例，Ⅲ级20例，Ⅳ级20例，比较各级别星形细胞瘤内最大相对局部脑血容量（rrCBV）；43例行DWI，其中Ⅱ级26例，Ⅲ级6例，Ⅳ级11例，比较各级别肿瘤间的表观扩散系数比率（ADCR）。结果 ^1HMRS组中Ⅱ、Ⅲ、Ⅳ级星形细胞瘤的Cho／Cr分别为2．709±1．228，5．812±2．374及5．289±1．462，3组之间差异有统计学意义（P〈0．05）。Ⅱ、Ⅲ、Ⅳ级星形细胞瘤的Lac／Cr分别为0．100±0．083、1．879±1．595及3．656±2．195，3组之间差异均有统计学意义（P〈0．01）。Ⅱ、Ⅲ、Ⅳ级星形细胞肿瘤的NAA／Cr之间差异无统计学意义（P〉0．05）；动态CE PI Ⅱ级与Ⅲ、Ⅳ级的rrCBV分别为1．379±0．739、2．654±1．072、3．218±1．565，3组差异有统计学意义（P〈0．01）。rrCBV与弥漫性星形细胞肿瘤的分级呈正相关（rs=0．601，P〈0．01）。rrCBV区分Ⅰ～Ⅱ级与Ⅲ～Ⅳ级的界值点为1．898（敏感性85．0％，特异性88．9％）；DWI组中Ⅱ级与Ⅲ＋Ⅳ级的ADCR差异无统计学意义（t=1．846，P=0．072）。结论 活体^1HMRS能反映不同级别星形细胞肿瘤的代谢差别；动态CEMRI可以揭示肿瘤内血管分布状况，量化病变的血管生成，为临床提供病生理学信息。依此可对弥漫性星形细胞肿瘤进行分级。
Objective To discuss the value of vivo proton MR spectroscopy , perfusion and diffusion imaging in grading of diffuse astrocytomas. Methods One hundred fifty-four cases with diffuse astrocytomas proved pathologically were collected. 35 cases with diffuse astrocytomas including 8 astrocytomas （WHO grade Ⅱ）, 13 anaplastic astrocytomas （ grade Ⅲ ） and 14 glioblastoma multiforms （grade Ⅳ ） underwent MR spectroscopy. The Cho/Cr,NAA/Cr and Lac/Cr of three groups in 35 cases were compared. The other 76 cases including 36 low-grade glial tumors （ grade Ⅱ ）, 20 anaplastic glial tumors （grade m ） and 20 glioblastoma multiforms （grade Ⅳ ） underwent conventional MR imaging and dynamic contrast-enhanced perfusion MR imaging before surgical resection or stereotactic biopsy, the characteristics of the curve and the value of the maximum relative regional cerebral volume （rrCBV） in the diffuse astrocytomas with various grades were analysed. Fourty-three cases of diffuse astrocytomas including 26 astrocytomas （grade Ⅱ）, 6 anaplastic astrocytomas （grade Ⅲ） and 11 glioblastoma multiformes （gradeⅣ ） underwent diffusion MRI and the apparent diffusion coefficient rate （ADCR）were compared. Resets The Cho/Cr of diffuse astrocytomas in three grades were 2. 709 ± 1. 228, 5.812± 2. 374 and 5. 289±1.462 respectively. There were statistically significant differences between astrocytomas and anaplastic astrocytomas, astrocytomas and glioblastoma multiformes for Cho/Cr （P 〈 0. 05 ）, but no significant differences between anaplastic astrocytomas and glioblastoma multiformes （P 〉 0. 05 ）. The Lae/Cr of diffuse astrocytomas in three groups were 0. 100± 0. 083, 1. 879±1. 595 and 3. 656 ± 2. 195 respectively, the differences among three groups were all significant （P 〈 0. 01 ）. No significant differences among three groups for NAA/Cr were found （ P 〉 0. 05 ）. The maximum rrCBV values of glial tumors with Ⅱ ,Ⅲ and Ⅳ grade were 1. 379 ±0. 739, 2. 654± 1.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第2期153-157,共5页
Chinese Journal of Radiology
关键词
星形细胞瘤
磁共振波谱学
扩散
分级
Astrocytoma
Magnetic resonance spectroscopy
Diffusion
Fractionation
