成人原始神经外胚层肿瘤：质子磁共振波谱成像结果及其在鉴别诊断中的潜在应用

Adult primitive neuroectodermal tumor: proton MR spectroscopic findings with possible application for differential diagnosis.

作者信息

Majós Carles, Alonso Juli, Aguilera Carles, Serrallonga Marta, Acebes Juan J, Arús Carles, Gili Jaume

机构信息

Institute de Diagnostic per la Imatge (IDI), Department of Diagnostic Imaging, Hospital Duran i Reynals, CSU de Bellvitge, Autovía de Castelldefels km 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.

出版信息

Radiology. 2002 Nov;225(2):556-66. doi: 10.1148/radiol.2252011592.

DOI:10.1148/radiol.2252011592

PMID:12409595

Abstract

PURPOSE

To assess the utility of proton magnetic resonance (MR) spectroscopy in the clinical categorization of primitive neuroectodermal tumors (PNETs) in adults.

MATERIALS AND METHODS

In vivo proton MR spectroscopy was performed with an echo time of 136 msec in nine adults with PNET, and findings were retrospectively compared with spectroscopic findings of 22 meningiomas, 12 low-grade astrocytomas, eight anaplastic astrocytomas, 23 glioblastomas, and 21 metastases. Nine resonances were semiquantitatively evaluated. Statistical analysis was performed by using Kruskal-Wallis and Mann-Whitney U tests. The Hochberg correction was applied for multiple comparisons. Results were prospectively validated in 24 tumors of the six types included in the study.

RESULTS

The resonances of choice for identifying PNET were alanine (P <.001) and glutamate and glutamine (P =.004), both decreased with respect to meningioma; choline increased with respect to low-grade (P <.001) and anaplastic astrocytoma (P =.055); and lipids at 1.30 ppm decreased and choline and other trimethyl-amine-containing compounds increased with respect to glioblastoma (P <.001 and P =.004, respectively) and metastasis (P <.001 and P =.021, respectively). We developed an algorithm for bilateral differential diagnosis between PNET and other tumor types. The leave-one-out method was used to test the five possible differential situations in the retrospective data set, with the following results: PNET versus meningioma, 31/23/5/3 (number of total/correct/unclassifiable/incorrect procedures); PNET versus low-grade astrocytoma, 21/19/2/0; PNET versus anaplastic astrocytoma, 17/6/9/2; PNET versus glioblastoma, 32/28/2/2; and PNET versus metastasis, 30/27/1/2. In total, 131 consecutive procedures produced 103 (79%) correct classifications and nine (7%) misclassifications. Twenty-five (78%) of 32 possible procedures in the prospective independent test set produced correct classifications and four (13%) produced incorrect classifications.

CONCLUSION

In vivo proton MR spectroscopy provides useful information in clinical differentiation between PNETs and common brain tumors in adults.

摘要

目的

评估质子磁共振（MR）波谱在成人生殖细胞原始神经外胚层肿瘤（PNET）临床分类中的应用价值。

材料与方法

对9例患有PNET的成年人进行了回波时间为136毫秒的活体质子MR波谱分析，并将结果与22例脑膜瘤、12例低级别星形细胞瘤、8例间变性星形细胞瘤、23例胶质母细胞瘤和21例转移瘤的波谱结果进行回顾性比较。对9种共振峰进行了半定量评估。采用Kruskal-Wallis检验和Mann-Whitney U检验进行统计学分析。采用Hochberg校正进行多重比较。研究中纳入的6种类型的24个肿瘤的结果进行了前瞻性验证。

结果

用于识别PNET的共振峰为丙氨酸（P <.001）以及谷氨酸和谷氨酰胺（P =.004），相对于脑膜瘤两者均降低；胆碱相对于低级别星形细胞瘤（P <.001）和间变性星形细胞瘤（P =.055）升高；相对于胶质母细胞瘤（分别为P <.001和P =.004）和转移瘤（分别为P <.001和P =.021），1.30 ppm处的脂质降低，胆碱和其他含三甲胺的化合物升高。我们开发了一种用于PNET与其他肿瘤类型之间双侧鉴别诊断的算法。采用留一法对回顾性数据集中的5种可能的鉴别情况进行测试，结果如下：PNET与脑膜瘤，31/23/5/3（总数/正确/无法分类/错误程序数）；PNET与低级别星形细胞瘤，21/19/2/0；PNET与间变性星形细胞瘤，17/6/9/2；PNET与胶质母细胞瘤，32/28/2/2；PNET与转移瘤，30/27/1/2。总共131次连续程序产生了103次（79%）正确分类和9次（7%）错误分类。前瞻性独立测试集中32次可能程序中的25次（78%）产生了正确分类，4次（13%）产生了错误分类。