Di Costanzo Alfonso, Scarabino Tommaso, Trojsi Francesca, Giannatempo Giuseppe M, Popolizio Teresa, Catapano Domenico, Bonavita Simona, Maggialetti Nicola, Tosetti Michela, Salvolini Ugo, d'Angelo Vincenzo A, Tedeschi Giocchino
Department of Health Sciences, University of Molise, Via de Sanctis 2, 86100, Campobasso, Italy.
Neuroradiology. 2006 Sep;48(9):622-31. doi: 10.1007/s00234-006-0102-3. Epub 2006 Jun 3.
Contrast-enhanced MR imaging is the method of choice for routine assessment of brain tumors, but it has limited sensitivity and specificity. We verified if the addition of metabolic, diffusion and hemodynamic information improved the definition of glioma extent and grade.
Thirty-one patients with cerebral gliomas (21 high- and 10 low-grade) underwent conventional MR imaging, proton MR spectroscopic imaging ((1)H-MRSI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) at 3 Tesla, before undergoing surgery and histological confirmation. Normalized metabolite signals, including choline (Cho), N-acetylaspartate (NAA), creatine and lactate/lipids, were obtained by (1)H-MRSI; apparent diffusion coefficient (ADC) by DWI; and relative cerebral blood volume (rCBV) by PWI.
Perienhancing areas with abnormal MR signal showed 3 multiparametric patterns: "tumor", with abnormal Cho/NAA ratio, lower ADC and higher rCBV; "edema", with normal Cho/NAA ratio, higher ADC and lower rCBV; and "tumor/edema", with abnormal Cho/NAA ratio and intermediate ADC and rCBV. Perienhancing areas with normal MR signal showed 2 multiparametric patterns: "infiltrated", with high Cho and/or abnormal Cho/NAA ratio; and "normal", with normal spectra. Stepwise discriminant analysis showed that the better classification accuracy of perienhancing areas was achieved when regarding all MR variables, while (1)H-MRSI variables and rCBV better differentiated high- from low-grade gliomas.
Multiparametric MR assessment of gliomas, based on (1)H-MRSI, PWI and DWI, discriminates infiltrating tumor from surrounding vasogenic edema or normal tissues, and high- from low-grade gliomas. This approach may provide useful information for guiding stereotactic biopsies, surgical resection and radiation treatment.
对比增强磁共振成像（MR成像）是脑肿瘤常规评估的首选方法，但它的敏感性和特异性有限。我们验证了添加代谢、扩散和血流动力学信息是否能改善胶质瘤范围和分级的界定。
31例脑胶质瘤患者（21例高级别和10例低级别）在接受手术和组织学确诊前，于3特斯拉场强下接受了常规MR成像、质子磁共振波谱成像（（1）H-MRSI）、扩散加权成像（DWI）和灌注加权成像（PWI）。通过（1）H-MRSI获得包括胆碱（Cho）、N-乙酰天门冬氨酸（NAA）、肌酸和乳酸/脂质在内的标准化代谢物信号；通过DWI获得表观扩散系数（ADC）；通过PWI获得相对脑血容量（rCBV）。
具有异常MR信号的强化周围区域显示出3种多参数模式：“肿瘤”，Cho/NAA比值异常、ADC较低且rCBV较高；“水肿”，Cho/NAA比值正常、ADC较高且rCBV较低；以及“肿瘤/水肿”，Cho/NAA比值异常且ADC和rCBV中等。具有正常MR信号的强化周围区域显示出2种多参数模式：“浸润”，Cho含量高和/或Cho/NAA比值异常；以及“正常”，波谱正常。逐步判别分析表明，当考虑所有MR变量时，强化周围区域的分类准确性更高，而（1）H-MRSI变量和rCBV能更好地区分高级别和低级别胶质瘤。
基于（1）H-MRSI、PWI和DWI的胶质瘤多参数MR评估能够区分浸润性肿瘤与周围血管源性水肿或正常组织，以及高级别和低级别胶质瘤。这种方法可能为指导立体定向活检、手术切除和放射治疗提供有用信息。
