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常规MRI的影像学特征联合~1H-MRS在脑胶质瘤分级诊断及预测术后复发的应用研究
Application of Conventional MRI Imaging Features Combined with 1H-MRS in Grading Diagnosis and Prediction of Postoperative Recurrence of Glioma
【作者】 王伟;
【导师】 沈龙山;
【作者基本信息】 蚌埠医学院 , 影像医学与核医学(专业学位), 2023, 硕士
【摘要】 目的:通过对脑胶质瘤患者术前行常规MRI及1H-MRS扫描,探讨常规MRI的影像学特征及1H-MRS在脑胶质瘤术前分级诊断及预测术后复发中的价值。方法:1、选取2020年1月至2021年12月在蚌埠医学院第一附属医院经临床诊断的脑胶质瘤患者共68例,术前均行头颅MRI平扫、增强及1H-MRS检查,利用3D-Slicer软件对MRI平扫及增强图像进行后处理,获得肿瘤实质区体积、肿瘤实质区表面积、瘤周水肿体积、瘤周水肿表面积以及瘤周水肿体积与肿瘤实质区体积之比等指标。同时应用磁共振机附带的后处理分析软件对1H-MRS图像进行后处理,在波谱图上选择感兴趣区(region of interest,ROI),将ROI放置于肿瘤实性部分及瘤周水肿区域。测定N-乙酰天门冬氨酸(N-acetylaspartate,NAA),胆碱(choline,Cho)和肌酸(creatine,Cr)等代谢物的浓度值,同时计算Cho/Cr和Cho/NAA的相对比值。使用SPSS 26软件对数据进行统计学分析,比较不同级别脑胶质瘤的上述定量指标的差异。2、全部脑胶质瘤患者均接受标准化手术治疗,通过门诊进行随访,术后随访12~24个月,根据再次手术组织病理学或随访证实诊断分为复发组与未复发组。比较复发与未复发患者的肿瘤实质区体积、瘤周水肿体积、瘤周水肿体积与肿瘤实质区体积之比、肿瘤实质区Cho/NAA、Cho/Cr的比值。采用ROC曲线评估上述指标对预测脑胶质瘤术后复发的诊断效能。结果:1、常规MRI的影像学特征结果显示,肿瘤实质区体积及表面积、瘤周水肿体积及表面积以及瘤周水肿体积与肿瘤实质区体积之比在HGG组和LGG组中差异具有统计学意义(P<0.05)。1H-MRS图像结果显示,肿瘤实质区与瘤周水肿区Cho/NAA、Cho/Cr的比值在HGG组和LGG组中差异具有统计学意义(P<0.05)。HGG组的上述各定量指标均高于LGG组。2、术后患者随访结果显示,复发组患者术前肿瘤实质区体积、瘤周水肿体积、瘤周水肿体积与肿瘤实质区体积之比、肿瘤实质区Cho/NAA、Cho/Cr值均高于未复发组,差异具有统计学意义(P<0.05)。绘制ROC曲线结果显示,上述指标对于预测脑胶质瘤术后复发具有较高的诊断价值(AUC>0.7)。结论:1、肿瘤实质区与瘤周水肿区的常规MRI的影像学特征及1H-MRS成像均可以有效提高脑胶质瘤术前分级诊断的准确性。2、术前肿瘤实质区体积、瘤周水肿体积、瘤周水肿体积与肿瘤实质区体积之比、肿瘤实质区Cho/NAA、Cho/Cr值在脑胶质瘤术后是否复发的诊断中具有一定价值,敏感度最高的指标是肿瘤实质区体积,特异度最高的指标是Cho/NAA、Cho/Cr。3、常规MRI的影像学特征联合1H-MRS对预测脑胶质瘤术后复发的诊断效能较其他单独指标更好,具有更高的诊断价值。
【Abstract】 Objective:To explore the imaging characteristics of conventional MRI and the value of 1H-MRS in preoperative grading diagnosis and prediction of postoperative recurrence of gliomas in patients with gliomas through preoperative conventional MRI and 1H-MRS scans.Methods:1.From January 2020 to December 2021,a total of 68 patients with brain glioma who were clinically diagnosed in the First Affiliated Hospital of Bengbu Medical College were selected.Before surgery,they all underwent MRI plain scan,enhanced scan and 1H-MRS examination.3D Slicer software was used to post process the MRI plain scan and enhanced images to obtain the volume of tumor parenchyma,the surface area of tumor parenchyma,the volume of peritumoral edema The surface area of peritumoral edema and the ratio of the volume of peritumoral edema to the volume of tumor parenchyma,etc.At the same time,the post-processing analysis software attached to the magnetic resonance machine was used to post-process the 1H-MRS image.The region of interest(ROI)was selected on the spectrogram,and the ROI was placed in the solid part of the tumor and the peritumoral edema area.The concentrations of N-acetylaspartate(NAA),choline(Cho)and creatine(Cr)were determined,and the relative ratios of Cho/Cr and Cho/NAA were calculated.SPSS 26 software was used to statistically analyze the data and compare the differences of the above quantitative indicators of different grades of brain glioma.2.All patients with brain glioma received standardized surgical treatment.They were followed up in the outpatient department for 12-24 months after surgery.They were divided into recurrent group and non recurrent group according to the diagnosis confirmed by reoperation histopathology or follow-up.The volume of tumor parenchyma,the volume of peritumoral edema,the ratio of peritumoral edema to tumor parenchyma,and the ratios of Cho/NAA and Cho/Cr in tumor parenchyma were compared between patients with and without recurrence.ROC curve was used to evaluate the efficacy of the above indicators in predicting postoperative recurrence of glioma.Results:1.The imaging characteristics of conventional MRI showed that the volume and surface area of tumor parenchyma,the volume and surface area of peritumoral edema,and the ratio of peritumoral edema volume to tumor parenchyma volume were significantly different between HGG group and LGG group(P<0.05).1H-MRS images showed that the ratios of Cho/NAA and Cho/Cr between the tumor parenchyma area and peritumoral edema area were significantly different between HGG group and LGG group(P<0.05).The above quantitative indexes in HGG group were higher than those in LGG group.2.The follow-up results of patients after operation showed that the volume of tumor parenchymal area,the volume of peritumoral edema,the ratio of peritumoral edema volume to tumor parenchymal area volume,and the Cho/NAA and Cho/Cr values of tumor parenchymal area in the relapsed group were higher than those in the non relapsed group before operation,and the difference was statistically significant(P<0.05).The ROC curve results showed that the above indicators were of high value in predicting the recurrence of glioma after operation(AUC>0.7).Conclusions:1.Conventional MRI features and 1H-MRS imaging of tumor parenchyma and peritumoral edema can effectively improve the accuracy of preoperative grading diagnosis of glioma.2.The volume of tumor parenchyma area before operation,the volume of peritumoral edema,the ratio of peritumoral edema volume to the volume of tumor parenchyma area,and the Cho/NAA and Cho/Cr values of tumor parenchyma area have certain value in the diagnosis of recurrence of glioma after operation.The most sensitive indicator is the volume of tumor parenchyma area,and the most specific indicators are Cho/NAA and Cho/Cr.3.The imaging features of conventional MRI combined with 1H-MRS have a better diagnostic value in predicting the recurrence of glioma after surgery than other independent indicators.
【Key words】 Glioma; Image features; Pathological grading; Magnetic resonance spectrum imaging;
- 【网络出版投稿人】 蚌埠医学院 【网络出版年期】2024年 03期
- 【分类号】R445.2;R739.41