Weber M A, Zoubaa S, Schlieter M, Jüttler E, Huttner H B, Geletneky K, Ittrich C, Lichy M P, Kroll A, Debus J, Giesel F L, Hartmann M, Essig M
Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
Neurology. 2006 Jun 27;66(12):1899-906. doi: 10.1212/01.wnl.0000219767.49705.9c.
To assess the value of spectroscopic and perfusion MRI for glioma grading and for distinguishing glioblastomas from metastases and from CNS lymphomas.
The authors examined 79 consecutive patients with first detection of a brain neoplasm on nonenhanced CT scans and no therapy prior to evaluation. Spectroscopic MRI; arterial spin-labeling MRI for measuring cerebral blood flow (CBF); first-pass dynamic, susceptibility-weighted, contrast-enhanced MRI for measuring cerebral blood volume; and T1-weighted dynamic contrast-enhanced MRI were performed. Receiver operating characteristic analysis was performed, and optimum thresholds for tumor classification and glioma grading were determined.
Perfusion MRI had a higher diagnostic performance than spectroscopic MRI. Because of a significantly higher tumor blood flow in glioblastomas compared with CNS lymphomas, a threshold value of 1.2 for CBF provided sensitivity of 97%, specificity of 80%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Because CBF was significantly higher in peritumoral nonenhancing T2-hyperintense regions of glioblastomas compared with metastases, a threshold value of 0.5 for CBF provided sensitivity, specificity, PPV, and NPV of 100%, 71%, 94%, and 100%. Glioblastomas had the highest tumor blood flow values among all other glioma grades. For discrimination of glioblastomas from grade 3 gliomas, sensitivity was 97%, specificity was 50%, PPV was 84%, and NPV was 86% (CBF threshold value of 1.4), and for discrimination of glioblastomas from grade 2 gliomas, sensitivity was 94%, specificity was 78%, PPV was 94%, and NPV was 78% (CBF threshold value of 1.6).
Perfusion MRI is predictive in distinguishing glioblastomas from metastases, CNS lymphomas and other gliomas vs MRI and magnetic resonance spectroscopy.
评估磁共振波谱成像（spectroscopic MRI）和灌注磁共振成像（perfusion MRI）在胶质瘤分级以及鉴别胶质母细胞瘤与转移瘤和中枢神经系统淋巴瘤方面的价值。
作者对79例首次在非增强CT扫描中发现脑肿瘤且在评估前未接受治疗的连续患者进行了检查。进行了磁共振波谱成像；动脉自旋标记磁共振成像用于测量脑血流量（CBF）；首过动态、磁敏感加权、对比增强磁共振成像用于测量脑血容量；以及T1加权动态对比增强磁共振成像。进行了受试者操作特征分析，并确定了肿瘤分类和胶质瘤分级的最佳阈值。
灌注磁共振成像的诊断性能高于磁共振波谱成像。由于胶质母细胞瘤的肿瘤血流量显著高于中枢神经系统淋巴瘤，CBF阈值为1.2时，敏感性为97%，特异性为80%，阳性预测值（PPV）为94%，阴性预测值（NPV）为89%。由于胶质母细胞瘤瘤周非增强T2高信号区域的CBF显著高于转移瘤，CBF阈值为0.5时，敏感性、特异性、PPV和NPV分别为100%、71%、94%和100%。在所有其他胶质瘤分级中，胶质母细胞瘤的肿瘤血流量值最高。对于鉴别胶质母细胞瘤与3级胶质瘤，敏感性为97%，特异性为50%，PPV为84%，NPV为86%（CBF阈值为1.4）；对于鉴别胶质母细胞瘤与2级胶质瘤，敏感性为94%，特异性为78%，PPV为94%，NPV为78%（CBF阈值为1.6）。
与磁共振成像和磁共振波谱相比，灌注磁共振成像在鉴别胶质母细胞瘤与转移瘤、中枢神经系统淋巴瘤及其他胶质瘤方面具有预测价值。
