Abstract:

Objective To investigate the combined value of multimodal functional magnetic resonance imaging （fMRI） and magnetic resonance spectroscopy （MRS） in the differential diagnosis of postoperative recurrence and pseudoprogression （PsP） of glioma. Methods One hundred and four patients with glioma confirmed by surgical pathology were selected from our hospital from September 2021 to March 2024， and the patients were divided into recurrence group （n = 70） and PsP group （n = 34） according to the revised glioma treatment response assessment criteria. Another group of 73 patients with glioma were selected for model validation. The general data， apparent diffusion coefficient （ADC） of multimodal fMRI parameters， standardized cerebral blood volume （CBV） and MRS indexes of the two groups were compared. The influencing factors of postoperative glioma recurrence were analyzed by logistic regression， and clinical efficacy of the combined treatment in the diagnosis of postoperative glioma recurrence and PsP was analyzed by receiver operating curve （ROC）. Results The level of ADC in the recurrence group was lower than that in the PsP group （P < 0.05）， and the levels of CBV， choline （Cho）/creatine （Cr） and Cho/ N-acetylaspartic acid （NAA）were higher （P < 0.05）. Logistic regression analysis showed that the levels of ADC， CBV， Cho/Cr and Cho/NAA were risk factors for postoperative recurrence of glioma （P < 0.05）. ROC showed that the combined use of multimodal fMRI and MRS in the differential diagnosis of postoperative glioma recurrence and PsP had an AUC of 0.916， outperforming the diagnostic accuracy of each individual modality. Validation of the combined model constructed with multimodal fMRI and MRS yielded an AUC of 0.929， 95% CI （0.844 ~ 0.976）， with a sensitivity of 88.46% and specificity of 91.49%. There was no statistical difference when compared to the AUC of the combined predictive model established in the earlier phase. Conclusion Multi-mode fMRI combined with MRS demonstrate high clinical value in the differential diagnosis of postoperative glioma recurrence and PsP， and it is worth to be popularized.

Key words: multimodal functional magnetic resonance imaging, magnetic resonance spectrum, brain glioma, postoperative recurrence, pseudoprogression