Department of Radiology, University of Washington, Seattle, Washington 98195-7115, USA.
J Magn Reson Imaging. 2012 Jan;35(1):56-63. doi: 10.1002/jmri.22801. Epub 2011 Oct 14.
To compare 3 Tesla (3T) multi-voxel and single-voxel proton MR spectroscopy (MRS), dynamic susceptibility contrast perfusion MRI (DSC), and diffusion-weighted MRI (DWI) for distinguishing recurrent glioma from postradiation injury.
We reviewed all 3T MRS, DSC and DWI studies performed for suspicion of malignant glioma recurrence between October 2006 and December 2008. Maximum Cho/NAA and Cho/Cr peak-area and peak-height ratios were recorded for both multi-voxel and single-voxel MRS. Maximum cerebral blood volume (CBV) and minimum apparent diffusion coefficient (ADC) were normalized to white matter. Histopathology and clinical-radiologic follow-up served as reference standards. Receiver operating characteristic curves for each parameter were compared.
Forty lesions were classified as glioma recurrence (n = 30) or posttreatment effect (n = 10). Diagnostic performance was similar for CBV ratio (AUC = 0.917, P < 0.001), multi-voxel Cho/Cr peak-area (AUC = 0.913, P = 0.002), and multi-voxel Cho/NAA peak-height (AUC = 0.913, P = 0.002), while ADC ratio (AUC = 0.726, P = 0.035) did not appear to perform as well. Single-voxel MRS parameters did not reliably distinguish tumor recurrence from posttreatment effects.
A 3T DSC and multi-voxel MRS Cho/Cr peak-area and Cho/NAA peak-height appear to outperform DWI for distinguishing glioma recurrence from posttreatment effects. Single-voxel MRS parameters do not appear to distinguish glioma recurrence from posttreatment effects reliably, and therefore should not be used in place of multi-voxel MRS.
比较 3 特斯拉（3T）多体素和单体素质子磁共振波谱（MRS）、动态对比增强磁共振灌注成像（DSC）和弥散加权成像（DWI）在鉴别复发性脑胶质瘤与放射性损伤中的作用。
我们回顾了 2006 年 10 月至 2008 年 12 月间因怀疑恶性脑胶质瘤复发而行 3T MRS、DSC 和 DWI 检查的所有病例。记录多体素和单体素 MRS 的最大 Cho/NAA 和 Cho/Cr 峰面积和峰高比。最大脑血容量（CBV）和最小表观弥散系数（ADC）均与白质进行标准化。以组织病理学和临床影像学随访作为参考标准。比较各参数的受试者工作特征曲线。
40 个病灶分为胶质瘤复发（n = 30）或治疗后效应（n = 10）。CBV 比值（AUC = 0.917，P < 0.001）、多体素 Cho/Cr 峰面积（AUC = 0.913，P = 0.002）和多体素 Cho/NAA 峰高（AUC = 0.913，P = 0.002）的诊断性能相似，而 ADC 比值（AUC = 0.726，P = 0.035）似乎效果不佳。单体素 MRS 参数不能可靠地区分肿瘤复发与治疗后效应。
3T DSC 和多体素 MRS Cho/Cr 峰面积和 Cho/NAA 峰高在鉴别脑胶质瘤复发与治疗后效应方面优于 DWI。单体素 MRS 参数不能可靠地区分脑胶质瘤复发与治疗后效应，因此不应替代多体素 MRS。
