Objective This study was aimed to investigate the application value of proton magnetic resonance spectros-copy(1H-MRS)and 3D arterial spin labeling(3D-ASL)for the differential diagnosis of radiation induced brain injury from glioma recurrence in glioma patients.Methods A retrospective analysis was performed by 40 glioma patients who underwent MRI plain scan+enhanced scan,DWI,and 1H-MRS and 3D-ASL examinations.The included patients were classified into a glioma recurrence(TR)group(n=23)and a radiation necrosis(RN)group(n=17)based on subse-quent pathologic analysis or clinical-radiological follow-up.The metabolite ratios(NAA/Cr,Cho/Cr,Cho/NAA)and cerebral blood flow(CBF)value in the region of interest(ROI)of lesions were measured and compared between the two groups.Moreover,demographic data,clinical data,and imaging parameters were statistically and the Pearson correlations a-nalysis between 1H-MRS and 3D-ASL measures was performed with SPSS software.Finally,the diagnostic efficacy of 1H-MRS,3D-ASL,and the combination of these two techniques was evaluated based on the receiver operating characteristic(ROC)curve analysis.Results In compare to contralateral normal brain tissue,TR group's lesion show increased Cho/Cr(2.527±0.565),Cho/NAA(3.074±1.407),and CBF[(76.666±15.961)ml·min-1·100g-1],while those measures Cho/Cr(1.275±0.266),Cho/NAA(1.280±0.389),and CBF[(33.359±8.283)ml·min-1·100g-1]exhibited decreasing trend in the RN group.Compared to the RN group,obvious measures were significantly higher in the TR group(P＜0.005),but the NAA/Cr(1.107±0.272)ratio was significantly decreased in the TR group(0.871±0.344)(P=0.025).Furthermore,a positively correlation was find between the CBF values and Cho/Cr and Cho/NAA(r=0.864 and 0.624,with P=0.001,respectively)in all subjects.ROC curve analysis suggested 100％sensitivity for 1H-MRS,3D-ASL,and 1H-MRS combined with 3D-ASL indicators in the differential diagnosis of TR and RN,obtaining the spe-cificity of 87.00％,91.30％,and 95.70％along with AUC values of 0.985,0.989,and 0.986,respectively.Conclusion Both 1H-MRS and 3D-ASL show good sensitivity in distinguishing RN from TR,and the combination of them can further im-prove their specificity.This suggests that 1H-MRS and 3D-ASL play an important role in the postoperative evaluation of glio-mas.
GliomaProton magnetic resonance spectroscopy3D arterial spin labellingTumour RecurrenceRa-diation necrosis
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