摘要
目的 探究多模式fMRI诊断脑胶质瘤术后复发及指导放化疗的价值.方法 选取我院行术后放化疗的脑胶质瘤患者 60 例的临床资料.比较术后复发 30 例(复发组)和假性进展(PsP)30 例(PsP组)一般资料、脑脊液外泌体复发相关标志物[微小RNA-146a(miR-146a)、微小RNA-424(miR-424)]、多模式fMRI参数[标准化脑血容量(CBV-norm)、ADC、代谢物胆碱(Cho)与肌酸/磷酸肌酸(Cr)比值(Cho/Cr)、Cho与N-乙酰天门冬氨酸(NAA)比值(Cho/NAA)].分析脑胶质瘤患者多模式fMRI参数与脑脊液外泌体miR-146a、miR-424 的相关性、诊断脑胶质瘤术后复发的价值.结果 复发组平均CBVnorm、最大CBVnorm、Cho/Cr、Cho/NAA及脑脊液外泌体miR-424 相对表达量均高于PsP组,ADC、脑脊液外泌体miR-146a相对表达量低于PsP组,差异有统计学意义(P<0.05);脑胶质瘤患者术后fMRI参数平均CBVnorm、最大CBVnorm、Cho/Cr、Cho/NAA与脑脊液外泌体miR-146a相对表达量呈负相关,与miR-424 相对表达量呈正相关,ADC与miR-146a相对表达量呈正相关,与miR-424 相对表达量呈负相关(P<0.05);平均CBVnorm、最大CBVnorm、ADC、Cho/Cr、Cho/NAA、脑脊液外泌体miR-146a、miR-424 相对表达量诊断脑胶质瘤术后复发的曲线下面积(AUC)分别为 0.733、0.829、0.749、0.779、0.810、0.719、0.707;平均CBVnorm、最大CBVnorm、ADC、Cho/Cr、Cho/NAA联合诊断术后复发的AUC为 0.932(95%CI为 0.837～0.981),诊断敏感度、特异度分别为 90.00%、90.00%.结论 多模式fMRI在鉴别诊断脑胶质瘤术后复发和PsP方面具有可靠诊断效能,可指导临床脑胶质瘤术后放化疗方案的制定.
Abstract
Objective To investigate the value of multimodal magnetic resonance functional imaging in diagnosing postopera-tive recurrence of glioma and guiding radiotherapy.Methods The clinical data of 60 patients with glioma who underwent post-operative radiotherapy in our hospital were selected.General information,cerebrospinal fluid exocytosis recurrence-related mark-ers[microRNA-146a(miR-146a),microRNA-424(miR-424)],multimodal fMRI parameters[standardized cerebral blood vol-ume(CBVnorm),ADC,metabolite choline(Cho)to creatine/phosphocreatine(Cr)ratio(Cho/Cr),and Cho to N-acetylaspartate(NAA)ratio(Cho/NAA)]were compared.The correlation of multimodal fMRI parameters with cerebrospinal fluid exosomes miR-146a and miR-424 in patients with glioma,as well as the value of diagnosing postoperative recurrence of glioma were analyzed.Results The mean CBVnorm,maximum CBVnorm,Cho/Cr,Cho/NAA and cerebrospinal fluid exosome miR-424 relative expressions were higher in the recurrence group than in the PsP group,and the ADC and cerebrospinal fluid exosome miR-146a relative expressions were lower than those in the PsP group(P<0.05);the mean postoperative magnetic resonance functional imaging parameters in patients with glioma CBVnorm,maximal CBVnorm,Cho/Cr,and Cho/NAA were nega-tively correlated with the relative expression of cerebrospinal fluid exosome miR-146a and positively correlated with miR-424,and ADC was positively correlated with the relative expression of miR-146a and negatively correlated with miR-424(P<0.05).The area under the curve(AUC)for the diagnosis of postoperative recurrence of glioma for mean CBVnorm,maximum CBVnorm,ADC,Cho/Cr,Cho/NAA,cerebrospinal fluid exosome miR-146a,and miR-424 relative expression was 0.733,0.829,0.749,0.779,0.810,0.719,and 0.707,respectively,and the maximum AUC for the combined diagnosis of mean CBVnorm,maximum CBVnorm,ADC,Cho/Cr,and Cho/NAA for postoperative recurrence was 0.932(95%CI 0.837-0.981),with diagnostic sensi-tivity and specificity of 90.00%and 90.00%,respectively.Conclusion Multimodal magnetic resonance functional imaging has reliable diagnostic efficacy in the differential diagnosis of postoperative glioma recurrence and PsP,which can guide the develop-ment of clinical postoperative radiotherapy regimens for glioma.
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