[1]张诚,麦麦提依明·托合提,王继超,等.多模态影像技术在胶质瘤复发与放射性坏死鉴别诊断中的价值[J].中国临床神经外科杂志,2022,27(10):812-815818.[doi:10.13798/j.issn.1009-153X.2022.10.004]
　ZHANG Cheng,MAIMAITIYIMING Tuoti,WANG Ji-chao,et al.Application value of multimodal imaging in differential diagnosis of glioma recurrence from radiation necrosis[J].,2022,27(10):812-815818.[doi:10.13798/j.issn.1009-153X.2022.10.004]
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多模态影像技术在胶质瘤复发与放射性坏死鉴别诊断中的价值()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年10期
页码:
812-815818
栏目:
论著
出版日期:
2022-10-31

文章信息/Info

Title:
Application value of multimodal imaging in differential diagnosis of glioma recurrence from radiation necrosis
文章编号:
1009-153X（2022）10-0812-04
作者:
张诚; 麦麦提依明·托合提; 王继超; 杨小朋; 吴永刚
183000乌鲁木齐，新疆维吾尔自治区人民医院神经外科（张诚、麦麦提依明·托合提、王继超、杨小朋、吴永刚）
Author(s):
ZHANG Cheng;  MAIMAITIYIMING Tuoti;  WANG Ji-chao;  YANG Xiao-peng;  WU Yong-gang
Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
关键词:
胶质瘤; 术后复发; 放射性坏死; 鉴别诊断; 多模态影像
Keywords:
Glioma;  Postoperative recurrence;  Differential diagnosis;  Radiation necrosis;  Magnetic resonance imaging;  PET-CT
分类号:
R739.41;R445
DOI:
10.13798/j.issn.1009-153X.2022.10.004
文献标志码:
A
摘要:
目的 探讨多模态影像技术在脑胶质瘤复发和放射性坏死鉴别诊断中的应用价值。方法 回顾性分析2016年6月至2021年12月手术治疗并经术后病理检查确诊的45例胶质瘤的临床资料。以二次手术或穿刺活检病理检查结果作为诊断胶质瘤复发和放射性坏死的金标准。术后3~6个月，灌注加权成像（PWI）检测相对脑血容量（rCBV），弥散成像（DWI）检测表观弥散系数（ADC），磁共振波谱（MRS）检测N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）等参数并计算Cho/NAA、Cho/Cr比值，PET-CT检测标准摄取值（SUV）。结果 45例中，胶质瘤复发34例（复发组），放射性坏死11例（坏死组）。复发组rCBV、SUV、Cho/NAA值明显大于坏死组（P<0.05），而ADC值明显小于坏死组（P<0.05）；两组Cho/Cr值无统计学差异（P>0.05）。ROC曲线分析显示，rCBV、ADC、Cho/NAA、Cho/Cr、SUV均具有鉴别价值，其中rCBV效果最佳（P<0.05）；而Cho/Cr无明显鉴别意义（P>0.05）。rCBV、ADC、Cho/NAA、Cho/Cr、SUV联合鉴别的敏感度、特异度分别为99%和100%，明显优于单一指标（P<0.01）。结论单纯应用MRI或PET-CT某一序列或单一检查手段鉴别胶质瘤复发与放射性坏死具有一定局限性，联合应用PWI、DWI、MRS、PET-CT，可显著提高鉴别诊断准确率，对制定个体化治疗方案具有重要临床意义。
Abstract:
Objective To explore the application value of multimodal imaging in the differential diagnosis of glioma recurrence from radiation necrosis. Methods The clinical data of 45 patients with glioma who underwent microsurgery from June 2016 to December 2021 were retrospectively analyzed. The gold standard for the diagnosis of glioma recurrence and radiation necrosis was the pathological examination after second operation or biopsy. Within 3 to 6 months after operation, the relative cerebral blood volume (rCBV) was detected by perfusion weighted imaging (PWI); the apparent diffusion coefficient (ADC) was detected by diffusion imaging (DWI); the parameters of N-acetylaspartate (NAA), choline (Cho) and creatine (Cr) were detected by magnetic resonance spectroscopy (MRS) and the ratio of Cho/NAA and Cho/Cr was calculated; the standard uptake value (SUV) was detected by PET-CT. Results Of these 45 patients, 34 patients were glioma recurrence (recurrence group), and 11 radiation necrosis (necrosis group). The values of rCBV, SUV and Cho/NAA in the recurrence group were significantly higher than those in the necrosis group (P<0.05), while the ADC values in the recurrence group were significantly lower than those in the necrosis group (P<0.05). There was no significant difference in Cho/Cr between both groups (P>0.05). ROC curve analysis showed that rCBV, ADC, Cho/NAA, Cho/Cr and SUV had differential value, and rCBV was the best (P<0.05). However, Cho/Cr had no significant difference (P>0.05). The sensitivity and specificity of rCBV, ADC, Cho/NAA, Cho/Cr combined with SUV were significantly better than that of single imaging parameter (P<0.01), with a sensitivity and specificity of 99% and 100%, respectively. Conclusions MRI or PET-CT alone has certain limitations in differentiating glioma recurrence from radiation necrosis. Combined application of PWI, DWI, MRS and PET-CT can significantly improve the accuracy of differential diagnosis, which has important clinical significance for making individualized treatment plan.

参考文献/References:

[1]Robles PD, Fiest KM, Frolkis AD, et al. The worldwide incidence and prevalence of primary brain tumors: a systematic review and meta-analysis [J]. Neuro-oncol, 2015, 17(6): 776-783.
[2]中国医师协会神经外科医师分会脑胶质瘤专业委员会. 胶质瘤多学科诊治（MDT）中国专家共识[J]. 中华神经外科杂志，2018，34：113-118.
[3]Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radio-therapy alone on survival in glioblastoma in a randomised phase Ⅲ study: 5-year analysis of the EORTC-NCIC trial [J]. Lancet Oncol, 2009, 10(5): 459-466.
[4]Alexiou GA, Tsiouris S, Kyritsis AP, et al. Glioma recur-rence versus radiation necrosis:accuracy of current imaging modalities [J]. J Neurooncol, 2009, 95(1): 1-11.
[5]国家卫生健康委员会医政医管局. 脑胶质瘤诊疗规范（2018年版）[J]. 中华神经外科杂志，2019，35：217-239.
[6]Klepper LI. Method of calculating the equivalent tumor dose as a function as to irradiated tumor tissue volume [J]. Med Tekh, 2001, 21(4): 15-20.
[7]Yoo RE, Choi SH. Recent application of advanced MR imaging to predict pseudoprogression in high-grade glioma patients [J]. Magn Reson Med Sci, 2016, 15(2): 165-177.
[8]唐晓宇，吴　刚，成之奇，等. 误诊为脑胶质瘤复发的放射性脑损伤1例报告并文献复习[J]. 临床神经外科杂志，2018，15（5）：387-390.
[9]Zeng QS, Li CF, Liu H, et al. Distinction between recurrent glioma and radiation injury using magnetic resonace spectroscopy in combination with diffusion- weighted imaging [J]. Int J Radiat Oncol Biol Phys, 2007, 68: 151-158.
[10]李振凯，杜红娣，王　莺，等. 多模态磁共振成像技术在胶质瘤术后复发及放射性损伤诊断中的应用研究[J]. 现代医用影像学，2019，28（12）：2582-2585.
[11]Sundgren PC, Fan XY, Weybright P, et al. Differentiation of recurrent brain tumor versus radiation injury using diffusion tensor imaging in patients with new contrast- enhancing lesions [J]. Magn Reson Imaging, 2006, 24(9): 1131-1142.
[12]陈孟达，李　强，王友良，等. 正电子发射计算机断层显像与多模态磁共振成像鉴别脑胶质瘤术后肿瘤复发与放射性脑损伤的价值研究[J]. 中国全科医学，2019，22（11）：1312-1318.
[13]沙　琳，范国光，曹　倩，等. 联合应用PWI与DWI鉴别胶质瘤复发与放射性损伤[J]. 中国临床医学影像杂志，2013，24（12）：841-845.
[14]刘铁军，郑英杰. 氢质子磁共振波谱联合弥散加权成像在鉴别脑胶质瘤术后复发及放射性损伤中的应用价值[J]. 广西医学，2016，38（5）：711-714.
[15]刘志成，颜林枫，孙颖志，等. 功能MRI鉴别胶质瘤术后复发及放射性脑损伤的影像学研究进展[J]. 磁共振成像，2017，8（9）：704-710.

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备注/Memo

备注/Memo:
（2022-04-10收稿，2022-07-22修回）
基金项目：新疆维吾尔自治区自然科学基金（2019D01C107）
通讯作者：吴永刚，E-mail：wyg931543@sina.com
更新日期/Last Update: 2022-11-30