The Value of Magnetic Resonance Spectroscopy in Differentiating Gliomas from Brain Metastases：a Meta-analysis

doi:10.12114/j.issn.1007-9572.2018.00.360

Abstract

Abstract: Background　Magnetic resonance spectroscopy （MRS） imaging can non-invasively analyze the changes of various metabolites in living tissue，and has great clinical value for the diagnosis，pathological grading and prognosis evaluation of tumor properties.In recent years，it has been gradually applied to differential diagnosis of glioma and brain metastatic tumor，but the research conclusions reported in domestic and foreign literatures are inconsistent.Objective　To evaluate the clinical value of MRS in differentiating gliomas from brain metastases using meta-analysis methods.Methods　Digital knowledge service platforms，such as Cochrane Library，PubMed，EMBase，EMCC，OVID，CNKI，VIP and Wanfang Data Knowledge Service Platform were searched for relevant articles of MRS in differentiating glioma （glioma group） from brain metastases （brain metastases group） published in English and Chinese up to February 2018.Two researchers independently extracted data and assessed the relevant system evaluation literature according to diagnostic Newcastle-Ottawa Scale （NOS） tool.Meta analysis was performed by using Stata 12.0 software.Results　Fourteen articles and 460 patients were included.The results of meta-analysis showed that in the around tumor，the NAA/Cr and NAA/Cho in the glioma group were lower than those in the brain metastases group 〔SMD=-0.59，95%CI（-0.96，-0.22），P=0.002；SMD=-1.90，95%CI（-3.30，-0.51），P=0.007〕，and Cho/NAA and Cho/Cr were higher than those of brain metastases group 〔SMD=1.51，95%CI（0.95，2.07），P<0.001；SMD=1.42，95%CI（0.84，2.00），P<0.001〕.In the tumor area，there were no statistically significant differences in NAA/Cr，NAA/Cho，Cho/Cr between glioma group and brain metastases group 〔SMD=-0.28，95%CI（-0.67，0.10），P=0.153；SMD=-0.47，95%CI（-1.80，0.86），P=0.488；SMD=0.38，95%CI（-0.10，0.86），P=0.117〕.Cho/NAA in glioma group was higher than that in brain metastases group 〔SMD=0.47，95%CI（0.16，0.78），P=0.003〕.Conclusion　In the around tumor，the NAA/Cr，NAA/Cho in the glioma are lower than those in brain metastases，and Cho/NAA，Cho/Cr in the glioma are higher than those in brain metastases.In the tumor area，the Cho/NAA in the glioma is higher than that in brain metastases.It has important clinical value for the differentiation of glioma and brain metastases by contrasting analysis of the ratio of NAA/Cr，NAA/Cho，Cho/NAA and Cho/Cr in the peritumoral area through MRS.

Key words: Neoplasm metastasis, Brain metastases, Glioma, Magnetic resonance spectroscopy, Meta-analysis

摘要： 背景　磁共振波谱成像（MRS）可无创性分析活体组织多种代谢物的改变，对肿瘤性质的诊断、病理分级以及预后评估具有很大的临床价值，近年来已逐步应用于神经胶质瘤与脑转移瘤的鉴别诊断，但国内外文献报道的研究结论并不一致。目的　采用Meta分析的方法探讨MRS鉴别神经胶质瘤与脑转移瘤的临床价值。方法　计算机检索Cochrane Library、PubMed、EMBase、EMCC、OVID、中国知网、维普中文期刊数据库和万方数据知识服务平台等数据库关于MRS鉴别神经胶质瘤（神经胶质瘤组）与脑转移瘤（脑转移瘤组）的文献；检索时间为建库至2018年2月。两名研究者独立提取资料数据和评价纳入文献，依据纽卡斯尔-渥太华量表（NOS）评价纳入文献的质量。采用Stata 12.0软件进行Meta分析。结果　纳入14篇文献，460例患者。Meta分析结果显示，瘤周区，神经胶质瘤组N-乙酰天门冬氨酸（NAA）/肌酐（Cr）、NAA/胆碱（Cho）低于脑转移瘤组〔标准化均数差（SMD）=-0.59，95%CI（-0.96，-0.22），P=0.002；SMD=-1.90，95%CI（-3.30，-0.51），P=0.007〕，Cho/NAA、Cho/Cr高于脑转移瘤组〔SMD=1.51，95%CI（0.95，2.07），P<0.001；SMD=1.42，95%CI（0.84，2.00），P<0.001〕。瘤体区，神经胶质瘤组与脑转移瘤组NAA/Cr、NAA/Cho、Cho/Cr比较，差异均无统计学意义〔SMD=-0.28，95%CI（-0.67，0.10），P=0.153；SMD=-0.47，95%CI（-1.80，0.86），P=0.488；SMD=0.38，95%CI（-0.10，0.86），P=0.117〕；神经胶质瘤组Cho/NAA高于脑转移瘤组〔SMD=0.47，95%CI（0.16，0.78），P=0.003〕。结论　瘤周区，神经胶质瘤NAA/Cr、NAA/Cho低于脑转移瘤，Cho/NAA、Cho/Cr高于脑转移瘤；瘤体区，神经胶质瘤Cho/NAA高于脑转移瘤。通过MRS对比分析瘤周NAA/Cr、NAA/Cho、Cho/NAA和Cho/Cr，对神经胶质瘤与脑转移瘤的鉴别具有重要的临床价值。

关键词: 肿瘤转移, 脑转移瘤, 神经胶质瘤, 磁共振波谱, Meta分析

CHEN Xianrui,HUANG Jianqi,XU Jinping, et al. The Value of Magnetic Resonance Spectroscopy in Differentiating Gliomas from Brain Metastases：a Meta-analysis　[J]. Chinese General Practice, 2019, 22(20): 2464-2471. DOI: 10.12114/j.issn.1007-9572.2018.00.360.
陈先睿,黄建琪,许锦平等. 磁共振波谱成像鉴别神经胶质瘤与脑转移瘤价值的Meta分析[J]. 中国全科医学, 2019, 22(20): 2464-2471. DOI: 10.12114/j.issn.1007-9572.2018.00.360.

References

［1］StataCorp.Stata Statistical Software：Release 12［Z］．College Station，TX：StataCorp LP，2011.
［2］SCHMIDT F L，OH I S，HAYES T L.Fixed- versus random-effects models in meta-analysis：model properties and an empirical comparison of differences in results［J］．Br J Math Stat Psychol，2009，62（Pt 1）：97-128．DOI：10.1348/000711007X255327.
［3］HEDGES L V，PIGOTT T D.The power of statistical tests for moderators in meta-analysis［J］．Psychol Methods，2004，9（4）：426-445．DOI：10.1037/1082-989X.9.4.426.
［4］EGGER M，DAVEY SMITH G，SCHNEIDER M，et al．Bias in meta-analysis detected by a simple，graphical test［J］．BMJ，1997，315（7109）：629-634.
［5］唐雯，凌雪英，黄力.应用多体素磁共振波谱成像鉴别脑胶质瘤与单发脑转移瘤［J］．暨南大学学报（自然科学与医学版），2012，33（6）：615-619．DOI：10.3969/j.issn.1000-9965.2012.06.016.
TANG W，LING X Y，HUANG L.The application of multi-voxel magnetic resonance spectroscopy in differentiating gliomas from solitary intracranial metastases［J］．Journal of Jinan University（Natural Science & Medicine Edition），2012，33（6）：615-619．DOI：10.3969/j.issn.1000-9965.2012.06.016.
［6］陈鑫，张永利，唐震，等．MR弥散、灌注、波谱成像在单发脑转移瘤与恶性胶质瘤鉴别诊断中的价值［J］．实用放射学杂志，2008，24（11）：1450-1453，1466．DOI：10.3969/j.issn.1002-1671.2008.11.004.
CHEN X，ZHANG Y L，TANG Z，et al．Differentiation between solitary metastases and high-grade gliomas by using diffusion，perfusion and proton spectroscopic MR imaging［J］．Journal of Practical Radiology，2008，24（11）：1450-1453，1466．DOI：10.3969/j.issn.1002-1671.2008.11.004.
［7］周高峰，王小宜，廖伟华，等．氢质子磁共振波谱鉴别孤立脑转移瘤与高级别脑胶质瘤的临床应用价值［J］．实用放射学杂志，2007，23（1）：1-5．DOI：10.3969/j.issn.1002-1671.2007.01.001.
ZHOU G F，WANG X Y，LIAO W H，et al．Clinical applied value of 1H-MRS in the differentiation of solitary metastasis and brain high-grade gliomas［J］．Journal of Practical Radiology，2007，23（1）：1-5．DOI：10.3969/j.issn.1002-1671.2007.01.001.
［8］邓治强，沈桂权，朱良旭，等．高级别胶质瘤和脑转移瘤的二维多体素氢质子磁共振波谱［J］．四川医学，2009，30（7）：1154-1155．DOI：10.3969/j.issn.1004-0501.2009.07.079.
DENG Z Q，SHEN G Q，ZHU L X，et al．Comparative study of high-grade gliomas and brain metastases with two-dimensional multivoxel proton magnetic resonance spectroscopy［J］．Sichuan Medical Journal，2009，30（7）：1154-1155．DOI：10.3969/j.issn.1004-0501.2009.07.079.
［9］陆永明，丁庆国，陈振湖，等．1HMRS对高级别脑胶质瘤与孤立脑转移瘤的鉴别诊断价值［J］．中国CT和MRI杂志，2010，8（1）：9-11．DOI：10.3969/j.issn.1672-5131.2010.01.003.
LU Y M，DING Q G，CHEN Z H，et al．The value of 1HMRS spectroscopy for the differential diagnosis of brain high-grade gliomas and solitary metastase［J］．Chinese Journal of CT and MRI，2010，8（1）：9-11．DOI：10.3969/j.issn.1672-5131.2010.01.003.
［10］孙庚喜，罗柏宁，张波.1H-MRS对脑转移瘤和恶性胶质瘤的鉴别诊断作用［J］．临床放射学杂志，2005，24（11）：955-959．DOI：10.3969/j.issn.1001-9324.2005.11.004.
SUN G X，LUO B N，ZHANG B.The study of 1HMRS in the differential diagnosis between brain metastases and malignant gliomas［J］．Journal of Clinical Radiology，2005，24（11）：955-959．DOI：10.3969/j.issn.1001-9324.2005.11.004.
［11］王雁冰，徐锐，张通.1H-MRS在高级别脑胶质瘤与脑转移瘤鉴别诊断中的应用［J］．中国临床实用医学，2010，4（10）：32-34．DOI：10.3760/cma.j.issn1673-8799.2010.10.15.
WANG Y B，XU R，ZHANG T.Comparative study of high-grade gliomas and brain metasmses with multivoxel proton magnetic resonance spectroscopy［J］．China Clinical Practical Medicine，2010，4（10）：32-34．DOI：10.3760/cma.j.issn1673-8799.2010.10.15.
［12］丁启星，韩崇明，王雁冰，等．DWI及多体素1H-MRS在高级别胶质瘤与单发转移瘤中的鉴别诊断价值［J］．中国实用医刊，2012，39（22）：47-50．DOI：10.3760/cma.j.issn.1674-4756.2012.22.020.
DING Q X，HAN C M，WANG Y B，et al．Differential diagnostic value of DWI and multi-voxel 1H-MRS for high-grade gliomas and single metastasis of tumor［J］．Chinese Journal of Practical Medicine，2012，39（22）：47-50．DOI：10.3760/cma.j.issn.1674-4756.2012.22.020.
［13］TSOUGOS I，SVOLOS P，KOUSI E，et al．Differentiation of glioblastoma multiforme from metastatic brain tumor using proton magnetic resonance spectroscopy，diffusion and perfusion metrics at 3 T［J］．Cancer Imaging，2012，12：423-436．DOI：10.1102/1470-7330.2012.0038.
［14］SERVER A，JOSEFSEN R，KULLE B，et al．Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors［J］．Acta Radiol，2010，51（3）：316-325．DOI：10.3109/02841850903482901.
［15］CHIANG I C，KUO Y T，LU C Y，et al．Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy，diffusion，and perfusion imagings［J］．Neuroradiology，2004，46（8）：619-627．DOI：10.1007/s00234-004-1246-7.
［16］LAW M，CHA S，KNOPP E A，et al．High-grade gliomas and solitary metastases：differentiation by using perfusion and proton spectroscopic MR imaging［J］．Radiology，2002，222（3）：715-721．DOI：10.1148/radiol.2223010558.
［17］FAN G，SUN B，WU Z，et al．In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases［J］．Clin Radiol，2004，59（1）：77-85.
［18］王子文，段阳，杨本强，等．氢质子磁共振波谱鉴别恶性胶质瘤与单发性脑转移瘤的价值［J］．中国临床实用医学，2017，8（1）：33-37．DOI：10.3760/cma.j.issn.1673-8799.2017.01.009.
WANG Z W，DUAN Y，YANG B Q，et al．The value of 1 H-MRS in identification of malignant glioma and solitary brain metastases［J］．China Clinical Practical Medicine，2017，8（1）：33-37．DOI：10.3760/cma.j.issn.1673-8799.2017.01.009.
［19］WELLS G A，SHEA B，WELCH V，et al．The Newcastle Ottawa Scale （NOS） for assessing the quality of nonrandomized studies in metaanalyses［EB/OL］．［2016-05-18］．http：//www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
［20］DIAMANDIS E，GABRIEL C P S，WüRTEMBERGER U，et al．
MR-spectroscopic imaging of glial tumors in the spotlight of the 2016 WHO classification［J］．J Neurooncol，2018，139（2）：431-440．DOI：10.1007/s11060-018-2881-x.
［21］傅常宇，刘耀华，杨宏宽，等．磁共振波谱技术在胶质瘤代谢研究中的应用进展［J］．中华神经外科疾病研究杂志，2014，13（2）：190-192.
FU C Y，LIU Y H，YANG H K，et al．Advances in the application of magnetic resonance spectroscopy in the study of glioma metabolism［J］．Chinese Journal of Neurosurgical Disease Research，2014，13（2）：190-192.
［22］SHUKLA G，ALEXANDER G S，BAKAS S，et al．Advanced magnetic resonance imaging in glioblastoma：a review［J］．Chin Clin Oncol，2017，6（4）：40．DOI：10.21037/cco.2017.06.28.
［23］CHIANG G C，KOVANLIKAYA I，CHOI C，et al．Magnetic resonance spectroscopy，positron emission tomography and radiogenomics-relevance to glioma［J］．Front Neurol，2018，9（1）：33．DOI：10.3389/fneur.2018.00033.
［24］于昊，王显龙，冯吕金，等．应用MRI鉴别诊断高级别胶质瘤与单发脑转移瘤的研究进展［J］．实用医学杂志，2014，30（19）：3192-3194．DOI：10.3969/j.issn.1006-5725.2014.19.057.
YU H，WANG X L，FENG L J，et al．Advances in the differential diagnosis of high grade glioma and single brain metastatic tumor by MRI［J］．The Journal of Practical Medicine，2014，30（19）：3192-3194．DOI：10.3969/j.issn.1006-5725.2014.19.057.
［25］TONG T，YANG Z，CHEN J W，et al．Dynamic 1H-MRS assessment of brain tumors：a novel approach for differential diagnosis of glioma［J］．Oncotarget，2015，6（31）：32257-32265．DOI：10.18632/oncotarget.4899.

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