CAJ | 학술논문

目的：根据肿瘤实质区及瘤周水肿区代谢物的差异，评估磁共振波谱成像对鉴别高级别胶质瘤与单发性颅内转移瘤的价值。方法经手术病理证实的高级别脑胶质瘤23例及单发脑转移瘤15例，术前均行常规 MRI 及1 H-MRS检查。检测肿瘤实质区、瘤周水肿区胆碱（Cho）、肌酸（Cr）、N-乙酰天门冬氨酸（NAA）及脂质（Lip）、乳酸（Lac）的变化，计算 Cho ／Cr、Cho ／NAA 及 NAA／Cr 的比值进行比较。对瘤周 Cho ／Cr、Cho ／NAA、NAA／Cr 及肿瘤实质内 Cho ／Cr 的比值进行 ROC 曲线分析。结果高级别胶质瘤与单发脑转移瘤瘤周水肿区 Cho ／Cr、Cho ／NAA、NAA／Cr 及肿瘤实质内 Cho ／Cr 的比值差异有统计学意义（P ＜0．05）。ROC 曲线表明瘤周水肿区 Cho ／Cr比值为1．33时鉴别高级别脑胶质瘤与脑转移瘤的敏感度、特异度及曲线下面积分别为73．9％、100％、89．3％。而瘤周水肿区 Cho ／NAA 比值为1．25时鉴别高级别脑胶质瘤及脑转移瘤的敏感度、特异性及曲线下面积分别为76．2％、100％、90．7％。结论MRS 波谱分析，特别是对瘤周代谢物比值的测量及 ROC 曲线分析，能够有效鉴别高级别胶质瘤与脑转移瘤。
목적：근거종류실질구급류주수종구대사물적차이，평고자공진파보성상대감별고급별효질류여단발성로내전이류적개치。방법경수술병리증실적고급별뇌효질류23례급단발뇌전이류15례，술전균행상규 MRI 급1 H-MRS검사。검측종류실질구、류주수종구담감（Cho）、기산（Cr）、N-을선천문동안산（NAA）급지질（Lip）、유산（Lac）적변화，계산 Cho ／Cr、Cho ／NAA 급 NAA／Cr 적비치진행비교。대류주 Cho ／Cr、Cho ／NAA、NAA／Cr 급종류실질내 Cho ／Cr 적비치진행 ROC 곡선분석。결과고급별효질류여단발뇌전이류류주수종구 Cho ／Cr、Cho ／NAA、NAA／Cr 급종류실질내 Cho ／Cr 적비치차이유통계학의의（P ＜0．05）。ROC 곡선표명류주수종구 Cho ／Cr비치위1．33시감별고급별뇌효질류여뇌전이류적민감도、특이도급곡선하면적분별위73．9％、100％、89．3％。이류주수종구 Cho ／NAA 비치위1．25시감별고급별뇌효질류급뇌전이류적민감도、특이성급곡선하면적분별위76．2％、100％、90．7％。결론MRS 파보분석，특별시대류주대사물비치적측량급 ROC 곡선분석，능구유효감별고급별효질류여뇌전이류。
Objective To assess the value of MR spectroscopy (MRS)in differentiating solitary brain metastases from high-grade gliomas on the basis of differences in metabolite ratios in the intratumoral and peritumoral region.Methods A total of 23 patients with high-grade gliomas and 15 patients with solitary brain metastases underwent MRI and 1 H-MRS before surgery.A variety of metabolite peaks including Cho,Cr,NAA and Lip/Lac were detected in the per-itumoral areas and the tumoral core.The differences in the metabolite ratios were analyzed statistically.Cutoff values of Cho /Cr,Cho /NAA,and NAA/Cr ratios in the peritumoral edema,as well as Cho /Cr ratios in the tumoral core for distinguishing high-grade gliomas from metastases were determined by receiver operating characteristic (ROC)curve analysis.Results Significant differences were noted in the peritumoral Cho /Cr,Cho /NAA,and NAA/Cr ratios between high-grade gliomas and metastases.ROC analysis demonstrated a cutoff value of 1.33 for peritumoral Cho /Cr ratio to provide sensitivity,specificity and the area under the curve(AUC)of 73.9%,100%,89.3%,respectively. By using a cutoff value of 1.25 for peritumoral Cho /NAA ratio,the sensitivity was 76.2%,the specificity was 100%, and the AUC was 90.7%.Conclusion MRS can differentiate high-grade gliomas from solitary brain metastases,espe-cially with peritumoral measurements and analysis of ROC curve.