Yamasaki Fumiyuki, Kinoshita Yasuyuki, Takayasu Takeshi, Usui Satoshi, Kolakshyapati Manish, Takano Motoki, Tsuyuguchi Sayuru, Amatya Vishwa Jeet, Akiyama Yuji, Takeshima Yukio, Sugiyama Kazuhiko, Kurisu Kaoru
Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
World Neurosurg. 2018 Apr;112:e84-e94. doi: 10.1016/j.wneu.2017.12.078. Epub 2017 Dec 20.
The differentiation of germinoma from other tumors by conventional magnetic resonance imaging (MRI) can be very difficult. The purpose of our study was to determine whether diffusion-weighted imaging (DWI) and single-voxel proton magnetic resonance spectroscopy (1H-MRS) could provide additional useful information for a definitive diagnosis of germinomas.
Our hospital's Institutional Review Board approved this retrospective study. We reviewed imaging studies of 26 patients with histologically confirmed germinomas who were treated at our hospital between 2003 and 2016. We also studied 25 patients with pineal tumors, which included 14 nongerminomatous germ cell tumors (NGGCTs), 9 pineal parenchymal tumors (PPTs; including 3 pineocytomas, 4 PPTs of intermediate differentiation [PPTID], and 2 pineoblastomas) and 2 meningiomas. Patients underwent conventional MRI and advanced MRI, including DWI and/or 1H-MRS.
The germinoma group comprised 24 males and 2 females, ranging in age from 9.1 to 37.7 years (average, 17.5 years; median, 14.6 years). The NGGCT group was all male, ranging in age from 5.4 to 51.9 years (mean, 20.1 years; median, 14.1 years). In the PPT group, patient age ranged from 4.5 to 64.7 years (mean, 29.9 years; median, 30.7 years). High lipid peaks detected on 1H-MRS were observed in 16 of 16 examined germinomas. In contrast, in the pineocytomas, PPTID, pineoblastomas, and meningiomas, lipid peaks were small or absent in 10 of 10 examined tumors. In the NGGCT group, high lipid peaks on 1H-MRS were observed in 11 of 12 examined tumors; however, no tumors showed high intensity on DWI, with all low to high mixed intensity. ADC was statistically lower in the germinoma group compared with the NGGCT group (P = 0.0002).
Lower ADC values and high lipid peaks detected on 1H-MRS are characteristics of germinomas.
通过传统磁共振成像（MRI）鉴别生殖细胞瘤与其他肿瘤可能非常困难。我们研究的目的是确定扩散加权成像（DWI）和单体素质子磁共振波谱（1H-MRS）是否可为生殖细胞瘤的明确诊断提供额外的有用信息。
我院机构审查委员会批准了这项回顾性研究。我们回顾了2003年至2016年间在我院接受治疗的26例经组织学确诊的生殖细胞瘤患者的影像学研究。我们还研究了25例松果体区肿瘤患者，其中包括14例非生殖细胞性生殖细胞肿瘤（NGGCTs）、9例松果体实质肿瘤（PPTs；包括3例松果体细胞瘤、4例中等分化松果体实质肿瘤[PPTID]和2例松果体母细胞瘤）以及2例脑膜瘤。患者接受了传统MRI及包括DWI和/或1H-MRS在内的高级MRI检查。
生殖细胞瘤组包括24例男性和2例女性，年龄范围为9.1至37.7岁（平均17.5岁；中位数14.6岁）。NGGCT组均为男性，年龄范围为5.4至51.9岁（平均20.1岁；中位数14.1岁）。在PPT组中，患者年龄范围为4.5至64.7岁（平均29.9岁；中位数30.7岁）。在16例接受检查的生殖细胞瘤中，有16例在1H-MRS上检测到高脂质峰。相比之下，在松果体细胞瘤、PPTID、松果体母细胞瘤和脑膜瘤中，10例接受检查的肿瘤中有10例脂质峰较小或未检测到。在NGGCT组中，12例接受检查的肿瘤中有11例在1H-MRS上检测到高脂质峰；然而，没有肿瘤在DWI上表现为高信号，均为低至高混合信号。生殖细胞瘤组的表观扩散系数（ADC）在统计学上低于NGGCT组（P = 0.00
