Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors
Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors
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DOI：
10.3109/02841850903482901
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发表时间：
2010-04-01
期刊：
影响因子：
1.3
通讯作者：
Nakstad, Per H.
中科院分区：
文献类型：
--
作者：
Server, Andres;Josefsen, Roger;Nakstad, Per H.
目的：为了评估MR波谱（MRS）的价值，根据肿瘤内和瘤周区域代谢物比值的差异，使用短回波时间和中等回波时间（TE）区分孤立性脑转移瘤和高级别胶质瘤。材料和方法：我们对73例经组织学证实的脑内肿瘤患者进行了MR成像和MRS：53例高级别胶质瘤患者（34例GBM和19例AA）和20例转移性脑肿瘤患者。从肿瘤核心、瘤周水肿和对侧正常白色物质的光谱图中评估了中间TE时Cho/Cr、Cho/NAA和NAA/Cr的代谢物比率以及短TE时脂质的存在。统计分析高级别胶质瘤/GBM/AA与转移瘤之间代谢物比值的差异。结果：高级别胶质瘤/GBM/AA瘤周Cho/Cr、Cho/NAA、NAA/Cr比值与转移瘤比较差异有统计学意义（P < 0. 05），高级别胶质瘤/GBM/AA瘤周Cho/Cr、Cho/NAA、NAA/Cr比值与转移瘤比较差异有统计学意义（P < 0. 05）。ROC分析表明，肿瘤周围Cho/Cr比值的临界值为1.24，用于区分高级别胶质瘤和转移瘤的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为100%、88.9%、80.0%和100%。以瘤周Cho/NAA比值1.11为界值，敏感性为100%，特异性为91.1%，阳性预测值为83.3%，阴性预测值为100%。本研究的结果表明，MRS可以区分高级别胶质瘤和转移瘤，特别是与瘤周测量，支持MRS可以检测肿瘤周围水肿中肿瘤细胞浸润的假设。
Purpose: To assess the value of MR spectroscopy (MRS) using short and intermediate echo time (TE) in differentiating solitary brain metastases and high-grade gliomas on the basis of differences in metabolite ratios in the intratumoral and peritumoral region.Material and Methods: We performed MR imaging and MRS in 73 patients with histologically verified intraaxial brain tumors: 53 patients with high-grade gliomas (34 GBM and 19 AA) and 20 patients with metastatic brain tumors. The metabolite ratios of Cho/Cr, Cho/NAA, and NAA/Cr at intermediate TE and the presence of lipids at short TE were assessed from spectral maps in the tumoral core, peritumoral edema, and contralateral normal-appearing white matter. The differences in the metabolite ratios between high-grade gliomas/GBM/AA and metastases were analyzed statistically. Cutoff values of Cho/Cr, Cho/NAA, and NAA/Cr ratios in the peritumoral edema, as well as Cho/Cr and NAA/Cr ratios in the tumoral core for distinguishing high-grade gliomas/GBM/AA from metastases were determined by receiver operating characteristic (ROC) curve analysis.Results: Significant differences were noted in the peritumoral Cho/Cr, Cho/NAA, and NAA/ Cr ratios between high-grade gliomas/GBM/AA and metastases. ROC analysis demonstrated a cutoff value of 1.24 for peritumoral Cho/Cr ratio to provide sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of 100%, 88.9%, 80.0%, and 100%, respectively, for discrimination between high-grade gliomas and metastases. By using a cutoff value of 1.11 for peritumoral Cho/NAA ratio, the sensitivity was 100%, the specificity was 91.1%, the PPV was 83.3%, and the NPV was 100%.Conclusion: The results of this study demonstrate that MRS can differentiate high-grade gliomas from metastases, especially with peritumoral measurements, supporting the hypothesis that MRS can detect infiltration of tumor cells in the peritumoral edema.