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ENGLISH ABSTRACT
磁共振弥散张量成像联合磁共振波谱检查对脑神经胶质瘤临床分级、预后评估的价值分析
闫龙
吴鹏
王生海
宋延峰
杨爱莲
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240517-00580
Application of diffusion tensor imaging combined with magnetic resonance spectroscopy for clinical grading and prognosis assessment of brain glioma
Yan Long
Wu Peng
Wang Shenghai
Song Yanfeng
Yang Ailian
Authors Info & Affiliations
Yan Long
Department of CT Diagnosis, Yan'an People's Hospital, Yan'an 716000, Shaanxi Province, China
Wu Peng
Department of CT Diagnosis, Yan'an People's Hospital, Yan'an 716000, Shaanxi Province, China
Wang Shenghai
Department of CT Diagnosis, Yan'an People's Hospital, Yan'an 716000, Shaanxi Province, China
Song Yanfeng
Department of CT Diagnosis, Yan'an People's Hospital, Yan'an 716000, Shaanxi Province, China
Yang Ailian
Department of Imaging, Yan'an Ansai District People's Hospital, Yan'an 716000, Shaanxi Province, China
·
DOI： 10.3760/cma.j.cn341190-20240517-00580
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摘要

目的分析磁共振弥散张量成像（DTI）联合磁共振波谱（MRS）检查对脑神经胶质瘤临床分级、预后评估的价值。

方法回顾性分析延安市人民医院2010年1月至2023年12月收治的72例脑胶质瘤患者的临床资料，其中男40例，女32例；年龄范围25~76岁，年龄（40.3±6.8）岁；术前均行常规MRI平扫、增强扫描、磁共振弥散张量成像（DTI）、磁共振波谱（MRS）检查，并测量各向异性分数值（FA）、N-乙酰天冬氨酸（NAA）、胆碱复合物（Cho）、肌酐（Cr），计算NAA/Cho、Cho/Cr、NAA/Cr比值，剖析脑神经胶质瘤的影像学特征，分析上述指标对患者临床分级、预后评估的应用价值。

结果72例患者中，DTI成像结果显示：瘤周脑白质纤维束破坏中断；MRS成像特征：近似正常，或见Cho、Cr值升高，NAA值下降。35例（48.61%）可出现弥漫性轻中度强化，呈斑片状，强化区代表肿瘤级别较高。低级别胶质瘤（LGG）、高级别胶质瘤（HGG）瘤周水肿区FA［（0.20±0.06）×10 -3 mm 2/s比（0.62±0.08）×10 -3 mm 2/s、（0.17±0.05）×10 -3 mm 2/s比（0.62±0.09）×10 -3 mm 2/s］、NAA/Cho［（0.36±0.11）比（1.41±0.33）、（0.19±0.06）比（1.42±0.35）］、Cho/Cr［（2.39±0.51）比（1.12±0.26）、（3.81±0.94）比（1.12±0.28）］、NAA/Cr值［（0.75±0.24）比（1.52±0.31）、（0.38±0.12）比（1.52±0.29）］与相应健侧区比较，差异均有统计学意义（ t LGG=26.56、19.09、14.03、12.42， t HGG=27.64、21.90、17.34、22.97，均 P < 0.05）；LGG、HGG间的FA［（0.20±0.06）×10 -3 mm 2/s比（0.17±0.05）×10 -3 mm 2/s］、NAA/Cho［（0.36±0.11）比（0.19±0.06）］、Cho/Cr［（2.39±0.51）比（3.81±0.94）］、NAA/Cr［（0.75±0.24）比（0.38±0.12）］值比较，差异均有统计学意义（ t=2.26、7.85、8.17、7.95，均 P < 0.05）。术后6个月至3年进行随访显示：死亡组患者的Cho/Cr高于生存组［2.172（1.662，2.863）比2.729（2.431，3.689）］（ U=2.17， P < 0.05），而FA、NAA/Cho、NAA/Cr值在生存组与死亡组间比较，差异无统计学意义（ P > 0.05）。

结论DTI联合MRS可使脑神经胶质瘤显示特殊的影像学特征，为患者临床分级提供参考，且Cho/Cr与预后相关，可能是反映脑神经胶质瘤预后的潜在影像标记物。

神经胶质瘤;弥散磁共振成像;磁共振波谱学;天冬氨酸;胆碱;预后
ABSTRACT

ObjectiveTo analyze the value of diffusion tensor imaging (DTI) combined with magnetic resonance spectroscopy (MRS) in the clinical grading and prognosis assessment of brain glioma.

MethodsA retrospective analysis was conducted on the clinical data of 72 patients with brain glioma admitted to Yan'an People's Hospital from January 2010 to December 2023. The cohort included 40 males and 32 females, with ages ranging from 25 to 76 years and an average age of (40.3 ± 6.8) years. All patients underwent routine magnetic resonance imaging plain scans, contrast-enhanced ultrasound examination, DTI, and MRS prior to surgery. Measurements were conducted for fractional anisotropy (FA), N-acetyl aspartate (NAA), choline compounds (Cho), and creatinine (Cr). Additionally, the ratios of NAA/Cho, Cho/Cr, and NAA/Cr were calculated. The imaging characteristics of brain glioma were analyzed, and the clinical utility of these indicators for grading and prognosis assessment of brain glioma was evaluated.

ResultsDTI results of the 72 included patients revealed disruption of the white matter fiber tracts surrounding the tumors. MRS of the 72 included patients showed either approximately normal values or indicated elevated Cho and Cr levels, along with decreased NAA levels. Diffuse mild to moderate enhancement was observed in 35 patients (48.61%), presenting with a patchy pattern that suggested a higher tumor grade. When comparing low-grade gliomas (LGG) and high-grade gliomas (HGG) to the corresponding healthy tissue, significant differences were observed in FA value in the peritumoral edema region [(0.20 ± 0.06) × 10 -3 mm²/s vs. (0.62 ± 0.08) × 10 -3 mm²/s for LGG, and (0.17 ± 0.05) × 10 -3 mm²/s vs. (0.62 ± 0.09) × 10 -3 mm²/s for HGG] , NAA/Cho ratio [(0.36 ± 0.11) vs. (1.41 ± 0.33) for LGG, and (0.19 ± 0.06) vs. (1.42 ± 0.35) for HGG], Cho/Cr ratio [(2.39 ± 0.51) vs. (1.12 ± 0.26) for LGG, and (3.81 ± 0.94) vs. (1.12 ± 0.28) for HGG], and NAA/Cr ratio [(0.75 ± 0.24) vs. (1.52 ± 0.31) for LGG, and (0.38 ± 0.12) vs. (1.52 ± 0.29) for HGG]. All observed differences were statistically significant ( t LGG = 26.56, 19.09, 14.03, 12.42; t HGG = 27.64, 21.90, 17.34, 22.97, all P < 0.05). There were statistically significant differences in FA [(0.20 ± 0.06) × 10 -3 mm²/s vs. (0.17 ± 0.05) × 10 -3 mm²/s], NAA/Cho [(0.36 ± 0.11) vs. (0.19 ± 0.06)], Cho/Cr [(2.39 ± 0.51) vs. (3.81 ± 0.94)], and NAA/Cr [(0.75 ± 0.24) vs. (0.38 ± 0.12)] between LGG and HGG ( t = 2.26, 7.85, 8.17, 7.95, all P < 0.05). Follow-up conducted 6 months to 3 years postoperatively revealed that the Cho/Cr ratio in the death group was significantly higher than that in the survival group [2.172 (1.662, 2.863) vs. 2.729 (2.431, 3.689), U = 2.17, P < 0.05]. However, there were no statistically significant differences in FA, NAA/Cho, and NAA/Cr values between survival and death groups ( P > 0.05).

ConclusionsCombined DTI and MRS can reveal specific imaging characteristics of brain gliomas, providing valuable information for clinical grading of brain gliomas. Furthermore, the Cho/Cr ratio is associated with prognosis and may serve as a potential imaging biomarker for predicting the outcome of brain gliomas.

Glioma;Diffusion magnetic resonance imaging;Magnetic resonance spectroscopy;Aspartic acid;Choline;Prognosis
Yang Ailian, Email: mocdef.qabq803842168

Yan Long is currently working at the Department of Imaging, Yan'an Hospital of Traditional Chinese Medicine, Yan'an 716099, Shaanxi Province, China

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引用本文

闫龙,吴鹏,王生海,等. 磁共振弥散张量成像联合磁共振波谱检查对脑神经胶质瘤临床分级、预后评估的价值分析[J]. 中国基层医药,2025,32(03)：336-341.

DOI:10.3760/cma.j.cn341190-20240517-00580

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脑神经胶质瘤是颅内发病率较高的原发性恶性肿瘤，约占颅内原发肿瘤的60%，由于其生长具有侵袭性，呈弥漫性生长，预后较差且生存期较短，尤其以胶质母细胞瘤致残及病死率较高。目前主要的治疗方法为手术联合放化疗，但放化疗因存在一定的并发症而受制约 ［ 1 , 2 , 3 , 4 ］ 。术前磁共振弥散张量成像（DTI）、磁共振波谱成像（MRS）对脑神经胶质瘤的初步影像学诊断具有重大的意义，其能够对患者临床分级、预后评估进行综合分析，有利于患者的诊疗。因此，笔者对收治的72例脑神经胶质瘤患者临床资料进行回顾性分析，以评估DTI联合MRS在脑神经胶质瘤诊疗中的应用价值。现报告如下。
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备注信息
A
杨爱莲，Email： mocdef.qabq803842168
B

闫龙：采集数据、起草文章；吴鹏、王生海：统计分析、技术支持；宋延峰、杨爱莲：设计试验、起草文章

C

闫龙现在延安市中医医院影像科，延安 716099

D
闫龙, 吴鹏, 王生海, 等. 磁共振弥散张量成像联合磁共振波谱检查对脑神经胶质瘤临床分级、预后评估的价值分析[J]. 中国基层医药,2025,32(3):336-341. DOI:10.3760/cma.j.cn341190-20240517-00580.
E
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