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目的探讨联合扩散加权成像(DWI)、灌注加权成像(PWI)和磁共振波谱(MRS)在胶质瘤术后复发与放射性坏死鉴别诊断中的价值。方法 34例胶质瘤术后复发和20例放射性坏死患者采用Siemens Verio 3.0 T磁共振扫描仪行常规MRI、DWI、PWI或MRS检查。分别测量DWI的表观扩散系数(ADC)值和r ADC值、PWI的血流动力学参数和MRS的代谢物参数,利用两样本t检验和受试者工作特征曲线(ROC)分析各参数,并联合筛检DWI、PWI和MRS各自的最佳参数。结果 r ADC值、r CBV和Cho/NAA分别是DWI、PWI和MRS的最佳诊断参数,对两种疾病鉴别诊断均有统计学意义(P<0.05)。以Youden指数最大值作为诊断临界点,r ADC值诊断胶质瘤术后复发的敏感度和特异度分别为86.7%和72.9%。r CBV诊断胶质瘤术后复发的敏感度和特异度分别为76.5%和94.7%。Cho/NAA诊断胶质瘤术后复发的敏感度和特异度分别为77.8%和100%。联合r ADC值、r CBV和Cho/NAA诊断胶质瘤术后复发的敏感度和特异度分别为94.7%和100%。结论 DWI、PWI和MRS在胶质瘤术后复发与放射性坏死鉴别诊断中有重要价值,联合最佳参数有助于两者的鉴别诊断。
Objective To investigate the value of combined diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI) and magnetic resonance spectroscopy (MRS) in the differential diagnosis of glioma recurrence and radioactive necrosis. Methods 34 cases of postoperative recurrence of glioma and 20 cases of patients with radioactive necrosis by Siemens Verio 3.0 T magnetic resonance scanner using routine MRI, DWI, PWI or MRS examination. The apparent diffusion coefficient (ADC) value and r ADC value of DWI, hemodynamic parameters of PWI and MRS metabolite parameters were measured respectively. The parameters of two samples t test and receiver operating characteristic curve (ROC) The best parameters of DWI, PWI and MRS were screened. Results r ADC value, r CBV and Cho / NAA were the best diagnostic parameters for DWI, PWI and MRS, respectively. There was significant difference between the two methods (P <0.05). With the maximum Youden index as the diagnostic threshold, the sensitivity and specificity of r ADC value for the diagnosis of glioma recurrence were 86.7% and 72.9%, respectively. r CBV diagnosis of glioma recurrence sensitivity and specificity were 76.5% and 94.7%. Cho / NAA diagnosis of glioma recurrence after the sensitivity and specificity were 77.8% and 100%. The sensitivity and specificity of combined r ADC value, r CBV and Cho / NAA in the diagnosis of glioma recurrence were 94.7% and 100% respectively. Conclusions DWI, PWI and MRS are of great value in the differential diagnosis of recurrent gliomas and radioactive necrosis. The combination of optimal parameters is helpful for the differential diagnosis between them.