| Part One:The value of MR DWI and MRS in the diagnosis and graduation of gliomasObjective To investigate the clinical value of DWI and MRS in preoperative diagnosing and grading of gliomas.Methods Eighty patients with gliomas received routine MRI,DWI and1H-MRS examination,including HGG 44 cases and LGG 36 cases,Which was compared with pathology.Meanwhile,ADC value,NAA/Cho,NAA/Cr and Cho/Cr ratio in tumor parenchyma,peritumoral region(?1.0 cm and Contralateral normal brain parenchyma were measured,and compared the difference between each region.Finally,Drawing ROC curve of DWI,MRS value so as to evaluate its differential diagnostic value in HGG and LGG.Results(1)Based on tumor location,morphology,signal characteristics,Mass effect and enhancement degree,Routine MRI'grading diagnosis accuracy is 88.75%;(2)r ADC value in HGG and LGG tumor parenchyma(1.313±0.101,1.656±0.045)was significant lower than that in HGG and LGG peritumoral region(1.451±0.102,1.841±0.040)(P<0.01),and there was significant difference in tumor parenchyma and peritumoral region' r ADC value between in HGG and LGG(P<0.01);(3)The difference in NAA/Cho(0.536±0.177)versus(0.760±0.161),NAA/Cr(1.121±0.246)versus(1.305±0.158),Cho/Cr(3.216±0.497)versus(2.439±0.231)was significant between HGG' tumor parenchyma and LGG'tumor parenchyma(P<0.05).The difference in NAA/Cho(0.613±0.110)versus(1.202±0.162),NAA/Cr(1.333±0.061)versus(1.587±0.189),Cho/Cr(2.236±0.197)versus(2.041±0.148)was also significant between HGG' peritumoral region and LGG'peritumoral region(P<0.05).There was significant difference in NAA/Cho,NAA/Cr,Cho/Cr between HGG'tumor parenchyma,peritumoral region and LGG' tumor parenchyma,peritumoral region(P<0.05).Meanwhile,there was significant difference in NAA/Cho,NAA/Cr,Cho/Cr between tumor parenchyma and peritumoral region and contralateral normal brain parenchyma(P<0.05);(4)When r ADC 1.59 was regard as differential diagnosis threshold between HGG and LGG,it' sensitivity,specificity and accuracy was 83.3%,93.2%,and 92.50%,respectively;(5)When Cho/Cr 2.72 was regard as differential diagnosis threshold between HGG and LGG,it' sensitivity,specificity and accuracy was100%,80.6% and 91.25%,respectively.Which was superior to NAA/Cho and NAA/Cr.Conclusion DWI and MRS can contribute to preoperative diagnosing and grading of glioma,which was superior to routine MRI in diagnositic accuracy.Part two: Study on the infiltrating scope of High grade glioma through DTIObjective To investigate the clinical value of diffusion tensor imaging(DTI)in evaluating HGG infiltrating scope.Methods Fifty-four patients with HGG received routine MRI and DTI examination,including grade ? 25 cases and grade ? 29 cases.Then,ADC and FA value in tumor parenchyma,peritumoral region(?1cm vs 1.1-2cm vs 2.1-3cm)and Contralateral normal brain parenchyma were measured,and compared the difference between each region.Results(1)The ADC values in tumor parenchyma,peritumoral region(?1cm vs 1.1-2cm vs 2.1-3cm)and Contralateral normal brain parenchyma was 1047.45±82.21,1157.73±88.08 vs 1193.89±89.14 vs1062.34±66.69,and 797.66±16.14,respectively.The ADC value increased from tumor parenchyma to middle peritumoral region.There was significant difference in ADC value between tumor parenchyma,proximal and middle peritumoral region and distal peritumoral region(P<0.01),But there was no significant difference in ADC value between proximal peritumoral region and middle peritumoral region(P>0.05).The diference in ADC value between from tumor parenchyma to distal peritumoral region and contralateral normal brain parenchyma was significant(P<0.05).(2)The FA value from tumor parenchyma,peritumoral region(?1cm vs 1.1-2cm vs 2.1-3cm)to contralateral normal brain parenchyma was 0.238±0.010,0.249±0.011 vs 0.253±0.011 vs 0.257±0.009,and0.260±0.008,respectively.Which showed a rising tendency gradually.Significant difference was noted in FA value between tumor parenchyma and proximal peritumoral region(P<0.05),Significant difference was not noted in FA value between other neighboring two groups.Furthermore,the difference was significant in FA value between from tumor parenchyma to scope of HGG.middle peritumoral region and contralateral normal brain parenchyma(P<0.01),Significant difference was also found in FA value between proximal peritumoral region and distal peritumoral region(P<0.05).Conclusion DTI has certain guiding value for determining tumor cells infiltratingPart three: The value of DWI and MRS on early radiotherapy efficacy of gliomasObjective To investigate the value of DWI and 1H-MRS in evaluating early radiotherapy efficacy of gliomas.Methods Eighteen patients with glioma received routine MRI,DWI and1H-MRS examination pre-radiotherapy and post-radiotherapy 3 to 4 weeks,including grade ?3cases,grade ? 7 cases and grade ? 8 cases.r ADC and MRS(NAA/Cho,NAA/Cr,Cho/Cr)value in tumor parenchymaor tumor bed region and peritumoral region(scope was 1cm)were measured,Then these f MRI Parameter of pre-radiotherapy were compared with that of post-radiotherapy.Results(1)The Cho / NAA,NAA / Cr and Cho / Cr value in tumor parenchyma or tumor bed region pre-radiotherapy and post-radiotherapy was 2.54±1.56 vs 2.09±1.30,1.31±0.84 vs1.29±0.94,and 3.18±1.97 vs 2.31±1.24,respectively.There was significant difference in Cho/Cr value between pre-radiotherapy and post-radiotherapy(P<0.01);The Cho / NAA,NAA / Cr and Cho / Cr value in peritumoral region pre-radiotherapy and post-radiotherapy was 1.33±1.09 vs1.24±0.88,1.59±0.79 vs 1.06±0.59,and 1.85±0.78 vs1.48±0.66,respectively.There was significant difference in Cho/Cr value between pre-radiotherapy and post-radiotherapy(P<0.05).(2)The r ADC value in tumor parenchyma or tumor bed region and peritumoral region pre-radiotherapy and post-radiotherapy was 1.313±0.101 vs 1.761±0.134,and 1.425±0.118 vs1.774±0.152,respectively.The r ADC value of tumor parenchyma or tumor bed in regionpost-radiptherapy was significant higher than that in pre-radiotherapy(P<0.05).Conclusion DWI and MRS have certain value in the evaluation of early radiotherapy curative effect of brain glioma. |
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