Fudaba H, Shimomura T, Abe T, Matsuta H, Momii Y, Sugita K, Ooba H, Kamida T, Hikawa T, Fujiki M
From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
AJNR Am J Neuroradiol. 2014 Nov-Dec;35(11):2091-8. doi: 10.3174/ajnr.A4018. Epub 2014 Jul 3.
Pulsed arterial spin-labeling, DTI, and MR spectroscopy provide useful data for tumor evaluation. We evaluated multiple parameters by using these pulse sequences and the Ki-67 labeling index in newly diagnosed supratentorial gliomas.
All 32 patients, with grade II (3 each of diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma), grade III (3 anaplastic astrocytomas, 4 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma), and grade IV (14 glioblastomas and 1 glioblastoma with an oligodendroglioma component) cases underwent pulsed arterial spin-labeling, DTI, and MR spectroscopy studies by using 3T MR imaging. The following variables were used to compare the tumors: relative cerebral blood flow, fractional anisotropy; ADC tumor/normal ratios; and the Cho/Cr, NAA/Cho, NAA/Cr, and lactate/Cr ratios. A logistic regression and receiver operating characteristic analysis were used to assess parameters with a high sensitivity and specificity to identify the threshold values for separate grading. We compared the Ki-67 index with various MR imaging parameters in tumor specimens.
Significant correlations were observed between the Ki-67 index and the mean, maximum, and minimum ADC, Cho/Cr, and lactate/Cr ratios. The receiver operating characteristic analysis showed that the combination of the minimum ADC and Cho/Cr ratios could differentiate low-grade and high-grade gliomas, with a sensitivity and specificity of 87.0% and 88.9%, respectively. The mean and maximum relative cerebral blood flow ratios were used to classify glioblastomas from other-grade astrocytomas, with a sensitivity and specificity of 92.9% and 83.3%, respectively.
Our findings indicate that pulsed arterial spin-labeling, DTI, and MR spectroscopy are useful for predicting glioma grade. Additionally, the parameters obtained on DTI and MR spectroscopy closely correlated with the proliferative potential of gliomas.
脉冲动脉自旋标记、扩散张量成像（DTI）和磁共振波谱为肿瘤评估提供了有用的数据。我们使用这些脉冲序列及新诊断幕上胶质瘤的Ki-67标记指数评估了多个参数。
32例患者，包括Ⅱ级（弥漫性星形细胞瘤、少突胶质细胞瘤和少突星形细胞瘤各3例）、Ⅲ级（3例间变性星形细胞瘤、4例间变性少突胶质细胞瘤和1例间变性少突星形细胞瘤）和Ⅳ级（14例胶质母细胞瘤和1例伴有少突胶质细胞瘤成分的胶质母细胞瘤）病例，采用3T磁共振成像进行脉冲动脉自旋标记、DTI和磁共振波谱研究。使用以下变量比较肿瘤：相对脑血流量、各向异性分数；表观扩散系数（ADC）肿瘤/正常比值；以及胆碱/肌酸（Cho/Cr）、N-乙酰天门冬氨酸/胆碱（NAA/Cho）、N-乙酰天门冬氨酸/肌酸（NAA/Cr）和乳酸/肌酸（lactate/Cr）比值。采用逻辑回归和受试者工作特征分析来评估具有高敏感性和特异性的参数，以确定不同分级的阈值。我们比较了肿瘤标本中Ki-67指数与各种磁共振成像参数。
观察到Ki-67指数与平均、最大和最小ADC、Cho/Cr以及lactate/Cr比值之间存在显著相关性。受试者工作特征分析表明，最小ADC和Cho/Cr比值的组合可区分低级别和高级别胶质瘤，敏感性和特异性分别为87.0%和88.9%。平均和最大相对脑血流量比值用于将胶质母细胞瘤与其他级别的星形细胞瘤区分开来，敏感性和特异性分别为92.9%和83.3%。
我们的研究结果表明，脉冲动脉自旋标记、DTI和磁共振波谱有助于预测胶质瘤分级。此外，DTI和磁共振波谱获得的参数与胶质瘤的增殖潜能密切相关。
