High Magnetic Field Strength MRS In Glioma After Surgery To Identify Recurrence Clinical Application

Objective：Application3.0T multi-voxel MRS follow-up of glioma postoperativepatients to identify recurrence.Methods and Materials：1.Subjects：Through collectiong from january2010to January2013inChina-Japanese Union Hospital of Jilin University，total of60patients whoaccept patients with glioma resection and able to follow-up. Male patients of36cases,24cases of female patients, aged18-64years old, with an average age of44.2years old,had no MRI contraindications, the average follow-up time of21months.2.Equipment and data processing: Use the Netherlands PhilipsAchieva/Intera3.0T TX multi-source transmitter magnetic resonance scanningand imaging equipment,8-channel head coil as the transmitting and receivingcoils. The first line conventional cranial MR sequence scan, scan axis view, sagittal view,and coronal view, obtain T1WI, T2WI signal at last. Enhancedscanning applications gadolinium-DTPA (Magnevist) intravenous injection,enhanced scan the row axis view, sagittal view, coronal view,and get the T1WIsignal。TR2400ms, TE24ms, TI860ms, slice thickness5mm, layer spacing1.0mm, FOV24*24cm. Application of1H-MRS voxel point-resolvedspectroscopy (PRESS). TR2000ms, TE144ms, flip angle90°, slice thickness10mm, FOV24*24cm, Spectral scan taken T1WI enhancement region as aregion of interest （ROI）. The collected data application comes withpost-processing software for processing, auto-complete water signalsuppression and baseline correction, draw NAA, Cho, Cr wave peak and owncalculations Cho/Cr, Cho/NAA, NAA/Cr of the ratio.3.Clinical and Statistical Methods: The study after1month,3months,6months,12months underwent MRI enhanced follow-up, follow-up periodenhanced further MRS MRS to determine whether the glioma recurrence. LineMRS patients at the same time to strengthen the follow-up intensity. Andfollow-up results as the gold standard to determine whether the tumorrecurrence. Using the the SPSS13.0package, measurement data applications as mean±standard deviation, the groups were compared using t-test, P <0.05wasconsidered statistically difference. Take Cho/Cr>2and or and Cho/NAA>diagnosis of tumor recurrence, and calculate the sensitivity and specificity ofMRS diagnosis of glioma recurrence.4.Results: The first operation is not total resection in6patients, notincorporated into the group to continue to study. During1year follow-upprocess, the MRI scan did not show any enhanced and does not appear relatedto neurological symptoms in12cases, tumor recurrence can be excluded, notincluded in our research group and suspension of follow-up. During follow-up,MRI enhanced scans show enhancement, but died within a short, did notundergo an autopsy to determine whether tumor recurrence in2cases,suspension of the follow-up. During follow-up surgery area and its surroundingenhancement, with peripheral edema in40cases, to a strengthen patients in1case, strengthening of10patients3months,6months appear strengthen24patients,12months appear strengthen5patients. The enhanced underwentMRS, take valuable threshold2, that is, when Cho/Cr>2and or and Cho/NAA patients25cases, incorporated into in the group of MRS tumor recurrence, and the remaining15patients incorporated into in the MRSnon-recurrence group. Continue to enhance patient follow-up of40cases amonth to strengthen patients in1case, recurrent group, the Cho/Cr and Cho/NAA greater than2, diagnosed by MRI enhanced follow-up the patients forrecurrence;3months to strengthen the10patients, Cho/Cr>2and or and Cho/NAA is greater than2,4patients, diagnosed three cases of recurrence;6months to strengthen the24patients, Cho/Cr>2and or and Cho/NAAgreater than2in18patients, diagnosed17cases of recurrence;12months tostrengthen the10patients, Cho/Cr>2and or and Cho/NAA is greater than2,2patients, diagnosed two cases of recurrence.15patients in the non-recurrencegroup,12months to strengthen patients eventually diagnosed with recurrencein2cases. Comes with post-processing software derived metabolites peak andCho/Cr, Cho/NAA, NAA/Cr of the ratio of Cho/Cr, Cho/NAA betweenthe recurrence of brain tumors with non-recurrence statistically significant (P<0.05), but no significant difference between brain tumor recurrence andnon-recurrence of NAA/Cr (P>0.05). The final calculated a sensitivity of92%and a specificity of86.7%. Conclusion:High field strength MRS in glioma of recognition recurrence after highsensitivity and specificity, is an effective means of identification of gliomarecurrence.