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The Diagnostic Value of Apparent Diffusion Coefficient and Proton Magnetic Resonance Spectroscopy in the Grading of Pediatric Gliomas.

表观弥散系数和质子磁共振波谱对儿童胶质瘤分级的诊断价值 [j].

  • 影响因子:1.48
  • DOI:10.1097/RCT.0000000000001130
  • 作者列表:"Yao R","Cheng A","Liu M","Zhang Z","Jin B","Yu H
  • 发表时间:2021-03-01
Abstract

OBJECTIVE:The aims of this retrospective study were to assess the value of the quantitative analysis of apparent diffusion coefficient (ADC) and proton magnetic resonance spectroscopy (1H-MRS) metabolites in differentiating grades of pediatric gliomas. PATIENTS AND METHODS:Two hundred and nine pathology-confirmed pediatric gliomas (143 low-grade gliomas [LGGs] and 66 high-grade gliomas [HGGs]) were retrospectively analyzed on preoperative diffusion-weighted magnetic resonance imaging, of which 84 also underwent 1H-MRS. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and metabolites (choline/creatine ratio [Cho/Cr], N-acetylaspartate/creatine ratio [NAA/Cr], N-acetylaspartate/choline ratio [NAA/Cho], presence of lactate and lipid peaks) between LGGs and HGGs were analyzed. RESULTS:There were significant negative correlations between the ADC values and glioma grade. Receiver operating characteristic analysis showed that the cutoff ADCmean value of 1.192 × 10-3 mm2/s for the differentiation between low- and high-grade pediatric gliomas provided a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 77.6%, 80.3%, 78.5%, 89.5% and 62.4%, respectively; the cutoff ADCmin value of 0.973 × 10-3 mm2/s resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 86.0%, 90.9%, 87.6%, 95.3%, and 75.0%, respectively; the cutoff ADC ratio value of 1.384 resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 73.4%, 87.9%, 78.0%, 92.9%, and 60.4%, respectively. A tendency for a positive correlation was found between Cho/Cr and glioma grade. A negative correlation was demonstrated between NAA/Cr or NAA/Cho and glioma grade. Statistical analysis demonstrated a threshold value of 2.601 for Cho/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 81.8%, 51.7%, 71.4%, 76.3%, and 60.0%, respectively, in dividing LGGs and HGGs; a threshold value of 0.705 for NAA/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 76.4%, 75.9%, 76.2%, 85.7%, and 62.9%, respectively; a threshold value of 0.349 for NAA/Cho to provide a sensitivity, specificity, accuracy, PPV, and NPV of 87.3%, 86.2%, 86.9%, 92.3%, and 78.1%, respectively. CONCLUSIONS:The ADC values and metabolites appeared to be significantly correlated to grade in pediatric gliomas. The predictive values may be helpful for preoperative diagnostic predictions.

摘要

目的: 探讨表观扩散系数 (ADC) 和质子磁共振波谱 (1H-MRS) 代谢产物定量分析在儿童胶质瘤分级中的价值。 患者和方法: 回顾性分析了143例病理证实的儿童胶质瘤 (例低级别胶质瘤 [LGGs] 和66例高级别胶质瘤 [HGGs]),其中84例还接受了1H-MRS。平均肿瘤ADC (ADCmean) 、最小肿瘤ADC (ADCmin) 、肿瘤/正常脑ADC比值 (ADC比值) 、代谢产物 (胆碱/肌酸比值 [Cho/Cr] 、N-乙酰天门冬氨酸/肌酸比值 [NAA/Cr] 、分析了LGGs和HGGs之间的N-乙酰天冬氨酸盐/胆碱比率 [NAA/Cho] 、乳酸盐和脂质峰的存在。 结果: ADC值与胶质瘤分级呈显著负相关。受试者工作特征分析显示,1.192 × 10-3平方毫米cm/s的截止ADCmean值对儿童低级别和高级别胶质瘤的区分提供了77.6% 、80.3% 、78.5% 的敏感性、特异性、准确性、阳性预测值 (PPV) 和阴性预测值 (NPV),分别为89.5% 和62.4%;截止ADCmin值为0.973 × 10-3平方毫米/s,导致灵敏度、特异度、准确度、PPV和NPV分别为86.0% 、90.9% 、87.6% 、95.3% 和75.0%; 截止ADC比值值为1.384,导致灵敏度、特异度、准确度、PPV、和73.4% 的净现值,分别为87.9% 、78.0% 、92.9% 和60.4%。发现Cho/Cr与神经胶质瘤分级之间存在正相关的趋势。NAA/Cr或NAA/Cho与胶质瘤分级呈负相关。统计分析表明,Cho/Cr的阈值为2.601,以提供区分LGGs和HGGs的灵敏度、特异性、准确性、PPV和NPV分别为81.8% 、51.7% 、71.4% 、76.3% 和60.0%; NAA/Cr的阈值为0.705,以提供灵敏度,特异性,准确性,PPV和NPV分别为76.4% 、75.9% 、76.2% 、85.7% 和62.9%; NAA/Cho的阈值为0.349,以分别提供87.3% 、86.2% 、86.9% 、92.3% 、78.1% 和的灵敏度、特异性、准确度、PPV和NPV。 结论: ADC值和代谢产物似乎与儿童胶质瘤的分级显著相关。预测值可能有助于术前诊断预测。

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