Zeng Qing-Shi, Li Chuan-Fu, Zhang Kai, Liu Hong, Kang Xiao-Shui, Zhen Jun-Hui
Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, 250012, China.
J Neurooncol. 2007 Aug;84(1):63-9. doi: 10.1007/s11060-007-9341-3. Epub 2007 Feb 14.
To explore the usefulness of multivoxel 3D proton MR spectroscopy ((1)H-MRS) in assessing the recurrent contrast-enhancing areas at the site of the previously treated gliomas.
In 28 patients who had new contrast-enhancing lesions in the vicinity of the previously resected and irradiated high-grade glioma, 3D (1)H-MRS examinations were performed on a 3.0T MR scanner. Spectral data for N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) were analyzed in all patients. Receiver operating characteristic analysis was performed, and the threshold value for tumor differentiation was determined. Diagnosis of these lesions was assigned by means of histopathology and follow-up.
Diagnostic-quality 3D (1)H-MRS with quantifiable Cho, Cr, and NAA peaks was obtained in 92.9% of the cases. The Cho/NAA and Cho/Cr ratios were significantly higher in recurrent tumor than in radiation injury (P < 0.01), whereas the NAA/Cr ratios were lower in recurrent tumor than in radiation injury (P = 0.02). The Cho/Cr and Cho/NAA ratios were significantly higher in radiation injury than in normal-appearing white matter (P < 0.01), however, the NAA/Cr ratios were lower in radiation injury than in normal-appearing white matter (P = 0.01). Using receiver operating characteristic analysis, the resulting sensitivity, specificity and diagnostic accuracy of 3D (1)H-MRS were 94.1%, 100%, and 96.2%, respectively, based on the cut-off values of 1.71 for Cho/Cr or 1.71 for Cho/NAA or both as tumor criterion.
3D (1)H-MRS could differentiate recurrent tumor from radiation injury in patients with recurrent contrast-enhancing lesions in the vicinity of the previously treated gliomas.
探讨多体素三维质子磁共振波谱（(1)H-MRS）在评估先前治疗的胶质瘤部位复发的强化区域中的作用。
对28例在先前切除并接受放疗的高级别胶质瘤附近出现新的强化病变的患者，在3.0T磁共振扫描仪上进行三维(1)H-MRS检查。分析所有患者中N-乙酰天门冬氨酸（NAA）、胆碱（Cho）和肌酸（Cr）的光谱数据。进行受试者操作特征分析，并确定肿瘤鉴别诊断的阈值。通过组织病理学和随访对这些病变进行诊断。
92.9%的病例获得了具有可量化Cho、Cr和NAA峰的诊断质量的三维(1)H-MRS。复发性肿瘤中的Cho/NAA和Cho/Cr比值显著高于放射性损伤（P < 0.01），而复发性肿瘤中的NAA/Cr比值低于放射性损伤（P = 0.02）。放射性损伤中的Cho/Cr和Cho/NAA比值显著高于正常白质（P < 0.01），然而，放射性损伤中的NAA/Cr比值低于正常白质（P = 0.01）。使用受试者操作特征分析，基于Cho/Cr或Cho/NAA或两者的截断值为1.71作为肿瘤标准，三维(1)H-MRS的敏感性、特异性和诊断准确性分别为94.1%、100%和96.2%。
三维(1)H-MRS能够在先前治疗的胶质瘤附近出现复发性强化病变的患者中区分复发性肿瘤与放射性损伤。
