磁共振波谱在脑胶质瘤放疗中的应用价值

目的 利用多体素磁共振波谱（MRS）探讨脑胶质瘤放疗前后早期代谢的变化。方法 31例诊断明确的脑胶质瘤部分切除术后患者,在放疗前后1周内分别行MRI平扫、增强及MRS检查;在肿瘤强化区、瘤周水肿区设置感兴趣区域（ROI）,采用GE自带软件包Functool分别计算化疗前后代谢物浓度及其比值的变化。结果 放疗后肿瘤强化区域的胆碱（Cho）值较放疗前升高,差异无统计学意义（P＞0.05）;放疗前、后肿瘤强化区域N-乙酰天门冬氨酸（NAA）值分别为39.295±33.778、56.062±39.031,差异有统计学意义（P=0.02）;放疗后瘤周水肿区域Cho值下降、NAA值升高,但差异均无统计学意义（P＞0.05）;放疗后肿瘤强化区及瘤周水肿区Cho／肌酸（Cr）、Cho／NAA、NAA／Cr比值均较放疗前下降,但仅Cho／Cr比值差异有统计学意义（P＜0.05）。结论 MRS可以显示脑胶质瘤的肿瘤强化区及瘤周水肿区放疗后的早期代谢变化,能够较早反映肿瘤放疗的效果。     

42例脑胶质瘤及转移瘤放疗前后磁共振质子波谱变化

[目的]探讨脑胶质瘤及转移瘤放疗后磁共振质子波谱（^1 HMRS）的变化。[方法]脑胶质瘤及转移瘤患者42例分别在放疗前后测量肿瘤和对侧脑组织的N2乙酰天冬氨酸（NAA）、胆碱（Cho）、肌酐（Cr）、乳酸（Lac）、脂质（Lip）峰值。[结果]42例脑胶质瘤及转移瘤放射治疗后，^1 HMRS均表现为NAA、Cho、Cr降低，Cho及Cho／Cr降低最明显，放射性坏死灶可表现出乳酸——脂质峰（Lac-Lip峰）。[结论]^1 HMRS可评估肿瘤放疗后的代谢变化，是一种判断近期疗效较有价值的检查方法。     

氢质子磁共振波谱（^1H-MRS）分析对放射性脑坏死与脑肿瘤复发的鉴别作用

目的：探讨氢质子磁共振波谱分析（^1H-MRS）对放射性脑坏死和脑肿瘤复发的鉴别作用。方法：选择35例经放射治疗后,在常规MRI图像上发现原肿瘤部位或周边有新的异常强化灶的脑恶性胶质瘤、脑转移瘤患者,其中3—4级胶质瘤18例,脑转移瘤17例。多体素^1H-MRS采用PRESS序列。研究指标包括N-乙酰门冬氨酸（NAA）、胆碱（Cho）及肌酐（Cr）。结果：NAA、Cho及Cr下降或消失,NAAVCr比值与Cho／Cr比值均下降;脑肿瘤复发Cho上升,NAA明显下降。脑肿瘤复发和放射性脑坏死之间,Cho／Cr、Cho／NAA有统计学差异（P〈0．05）,NAAVCr无统计学差异（P〉0．05）。结论：^1H-MRS对脑肿瘤放射治疗后的脑坏死及脑肿瘤复发的评估和鉴别诊断有重要临床应用价值。     

1HMRS在鉴别脑内单发环形强化病变中的应用

目的：分析3.0T氢质子磁共振波谱成像（1HMRS）在鉴别脑内单发环形强化病变中的应用。方法应用PHILIPS 3.0T磁共振扫描仪对65例在MRI增强扫描时表现为脑内单发环形强化病变的患者治疗前行1HMRS扫描,经病理证实或临床确诊为30例高级别胶质瘤、23例单发脑转移瘤和12例脑脓肿。分别测量病灶中心及周围水肿区的NAA、Cho及Cr峰的峰下面积,计算NAA/Cr、Cho/Cr、NAA/Cho比值,并记录病灶中心Lac和Lip峰是否出现。对各参数值进行统计学分析,明确其对鉴别三种疾病的诊断价值。结果病灶中心的Cho值胶质瘤﹥转移瘤﹥脑脓肿;Cho/Cr值胶质瘤﹥脑脓肿（P﹤0.05）;NAA/Cho值脑脓肿﹥转移瘤﹥高级别胶质瘤;NAA及NAA/Cr在三组之间差异均无统计学意义。周围水肿区的NAA/Cr转移瘤组﹥脑脓肿组;Cho/Cr比值差异有显著统计学意义（P﹤0.001）,胶质瘤组﹥脑脓肿组﹥转移瘤组,高级别胶质瘤组明显高于单发脑转移瘤组（P=0.000）且Cho/Cr临界值为1.5650时诊断为高级别胶质瘤的敏感度为73.3%,特异度为94.4%,ROC曲线下面积为0.921。周围水肿区NAA/Cho差异有显著统计学意义（P﹤0.001）,转移瘤组高于胶质瘤组和脑脓肿组。高级别胶质瘤Lip峰出现率低于转移瘤和脑脓肿,转移瘤和脑脓肿组间比较差异无统计学意义。结论1HMRS可用于鉴别脑内单发环形强化病变,病灶中心的NAA/Cho和周围水肿区的Cho/Cr比值对高级别胶质瘤、单发脑转移瘤和脑脓肿的鉴别诊断具有重要意义。     

常规MRI与1H-MRS结合鉴别高级别脑胶质瘤与单发性脑转移瘤

目的 探讨常规磁共振成像（MRI）与氢质子磁共振波谱（1H-MRS）相结合在高级别脑胶质瘤与单发性脑转移瘤中诊断及鉴别诊断的价值。方法 选取我院收治经手术病理组织学证实的高级别脑胶质瘤患者27例与单发性脑转移瘤患者21例,进行常规MRI及1H-MRS检查。分析比较常规MRI的影像表现特征及1H-MRS代谢产物［N-乙酰天门冬氨酸（NAA）、胆碱（Cho）和肌酸（Cr）］变化情况。结果 常规MRI显示仅病变部位和水肿程度在两者间存在差异（P＜0.05）。1H-MRS高级别脑胶质瘤与单发性脑转移瘤瘤体区Cho／NAA值比较差异有统计学意义（P＜0.05）,而NAA／Cr、Cho／Cr值比较差异无统计学意义（P＞0.05）;两者瘤周区Cho／Cr、Cho／NAA值比较差异均有统计学意义（P＜0.05）,而NAA／Cr值比较差异无统计学意义（P＞0.05）。结论 常规MRI与1H-MRS相结合使高级别脑胶质瘤与单发性脑转移瘤诊断及鉴别诊断的准确性得到进一步提高,具有较高的临床应用价值。     

脑胶质瘤氢质子磁共振波谱代谢物与Ki-67抗原的相关性及其应用价值

摘 要：［目的］ 探讨胶质瘤氢质子磁共振波谱（1-H magnetic resonance spectroscopy,1H-MRS）所示代谢物值与Ki-67抗原的相关性及其应用价值。［方法］ 回顾性分析83例术前行1H-MRS检查、术后病理学结果为脑胶质瘤的患者资料,对比分析胶质瘤实质部位主要代谢物N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）及其比值（Cho/Cr、Cho/NAA、NAA/Cr）与Ki-67表达的相关性。［结果］ Cho/Cr、Cho/NAA比值与Ki-67表达呈正相关(r=0.257,P=0.019;r=0.329,P=0.002),NAA/Cr比值与Ki-67表达呈负相关(r=-0.206,P=0.049);Lip出现率与Ki-67表达呈正相关（r=0.304,P=0.005）。［结论］ 1H-MRS检查的各代谢物值与Ki-67表达关系密切,可有效反应脑胶质瘤的增殖活性,其中Cho/NAA比值的诊断价值最高。     

氢质子磁共振波谱联合磁共振成像对脑胶质瘤的诊断价值

目的探讨氢质子磁共振波谱(1H-MRS)联合磁共振成像(MRI)对脑胶质瘤的诊断价值。方法选取2015年10月至2016年10月间哈尔滨医科大学附属第二医院收治的48例脑胶质瘤患者,其中低级别脑胶质瘤30例,高级别脑胶质瘤18例。均在行MRI基础上行1H-MRS检查,检测N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和胆碱(Cho),分析患者肿瘤实质区与瘤周水肿区的低级别脑胶质瘤和高级别脑胶质瘤Cho/Cr和Cho/NAA的差异。结果 MRI扫描显示低级别脑胶质瘤和高级别脑胶质瘤的瘤周水肿区的水肿和肿瘤实质区的强化程度对比,差异均无统计学意义(均P>0.05)。1H-MRS扫描显示高级别脑胶质瘤的肿瘤实质区的Cho/Cr和Cho/NAA值与瘤周围水肿区的Cho/Cr值均高于低级别脑胶质瘤,差异均有统计学意义(均P<0.05)。而高级别脑胶质瘤和低级别脑胶质瘤瘤周水肿区的Cho/NAA值比较,差异无统计学意义(P>0.05)。结论在传统MRI扫描的基础上联合使用1H-MRS,可以提供定量的检测结果来评价肿瘤的恶性度,为脑胶质瘤做出准确的分级诊断。     

磁共振波谱在5-氟尿嘧啶热化疗治疗兔肝VX2移植瘤效果评价中的应用

目的 比较兔肝VX2移植瘤经介入性热化疗（ITC）治疗前后1H-MRS主要代谢物的变化,并与细胞凋亡指数（AI）进行相关性分析.方法 选取新西兰大白兔20只,采用组织块种植的方法成功制成兔VX2肝癌模型,10d后,待肿瘤直径≥10 mm时,分别于治疗前1天、治疗后第14天行常规磁共振成像（MRI）及磁共振波谱（MRS）扫描.使用Philips 1.5T MR成像仪,选取病灶不同感兴趣区（ROI）,分别测量治疗前、后不同ROI的观察肿瘤治疗前后的胆碱（Cho）峰值与脂质（Lip）峰值及两者比值的变化,免疫组织化学法及HE染色检测肿瘤细胞AI,并与MRS结果进行对照,分析不同ROI的主要代谢物变化规律.结果 在成功获得的1H-MRS波谱图中多数可见到6个主要的代谢物波峰,治疗前Cho峰、Lip峰均升高;治疗后Cho峰值较治疗前下降、Lip峰值则进一步升高,Cho/Lip比值降低,两两比较差异均有统计学意义（P＜0.05）;治疗后Cho/Lip峰值比与AI值呈负相关（r=-0.56,P=0.02）.结论 兔肝VX2移植瘤不同ROI的1H-MRS主要代谢物的变化情况与肿瘤细胞AI表达程度及范围一致;1H-MRS能反映VX2移植瘤ITC治疗前后肿瘤细胞凋亡和能量代谢变化情况.     

多体素1H磁共振波谱在脑胶质瘤诊断及分级中的应用研究

 目的　探讨多体素1H磁共振波谱在脑胶质瘤诊断及分级中的价值。方法　选取经手术病理或临床确诊的36例脑胶质瘤患者。采用美国GE公司Signa EXCITE HD 3.0T 超导型磁共振（MR）扫描仪对所有患者行颅脑常规核磁共振（MRI）扫描和二维多体素144 ms序列扫描。采用Functool软件包后处理,分别测定病变实质、病变周围及健侧相应区域的胆碱（Cho）／肌酸（Cr）、Cho／N-乙酰天门冬氨酸（NAA）、NAA／Cr比值及肌醇（MI）值的变化,并对结果进行统计学分析。结果　全组数据采用SAS8.2软件处理,结果显示：低级别胶质瘤和高级别胶质瘤瘤体区Cho／Cr、Cho／NAA、NAA／Cr比值及MI值分别比较差异有统计学意义（P＜0.05）;瘤周水肿区Cho／Cr、NAA／Cr比值分别比较差异有统计学意义（P＜0.05）,MI值比较差异无统计学意义（P＞0.05）。结论　1H-MRS在鉴别诊断脑胶质瘤中有重要价值,结合MR其他成像方法可对其做出较为准确的分级。     

磁共振功能成像在脑胶质瘤侵袭性行为评价中的作用

脑胶质瘤的侵袭常沿着有髓神经纤维和血管基底膜途径进行。MR功能成像包括MRS、PWI和DWI．具有一定的分子成像的能力。MRS代谢物浓度变化可以明确瘤体和瘤周的代谢物变化。Cho／Cr值自近瘤周区向远瘤周区有逐渐降低的趋势．而NAA／Cr则有升高趋势．符合胶质瘤沿白质纤维自近向远侵袭性生长的特点。MRI灌注成像rCBV对胶质瘤分级的预测具有一定价值。MRI弥散成像通过反映组织内水分子的扩散特性反映脑内肿瘤的病理变化,常以扩散张量成（DTI）、表观扩散系数（ADC）和白质纤维柬追踪~（V13来间接反映胶质瘤的生物学侵袭性特点。MR功能成像在评价脑胶质瘤侵袭性上具有一定价值,临床医生应把传统MRI与多种功能成像技术联合应用来提高MRI对胶质瘤侵袭性的认识。     

Early metabolic changes in metastatic brain tumors after Gamma Knife radiosurgery:<Superscript>1</Superscript>H-MRS study

Evaluation of early metabolic changes in metastatic brain tumors after Gamma Knife radiosurgery was performed by long-echo (TR, 2000ms; TE, 136 ms; 128–236 acquisitions) volume-selected single-voxel proton magnetic resonance spectroscopy (MRS). Eighty-five brain metastases in 81 patients were investigated before treatment and 16–18h thereafter. Standard metabolic ratios, namelyN-acetylaspartate (NAA)/creatine (Cr), phosphorylcholine/glycerophosphorylcholine (Cho)/Cr, NAA/Cho, lactate (Lac)/Cr, and mobile lipids (Lip)/Cr, were calculated, and comparison of their values before and after irradiation was done. No volumetric changes of any neoplasm were found in any case on the next day after treatment. At the same time, significant reduction of Cho/Cr (P<0.001) and NAA/Cr (P<0.01) ratios on the proton MRS of the tumor was disclosed. Reduction of Cho/Cr ratio was significantly more prominent in neoplasms with higher pretreatment Cho/Cr ratios (P<0.001) and heterogeneous contrast enhancement (P<0.01). Reduction of NAA/Cr ratio was predominantly determined by its pretreatment value (P<0.001). The observed decrease of Cho/Cr ratio probably reflects inhibition of proliferative activity and early apoptotic cell loss, whereas reduction of NAA/Cr may result from radiation-induced modulation of neuronal activity in the peritumoral brain tissue. Serial proton MRS represents a valuable diagnostic tool for evaluation of metabolic changes in intracranial neoplasms after radiosurgical treatment.     

申捷对放疗前后脑照射野内N-乙酰天门冬氨酸、胆碱及肌酸含量的影响

目的：利用磁共振波谱技术检测应用申捷（单唾液酸四己糖神经节苷钠）及放疗前后脑组织内N-乙酰天门冬氨酸、胆碱及肌酸含量变化,探讨申捷在预防及治疗早期放射性脑损伤中的作用。方法：将鼻咽癌患者随机分为两组,对照组给予放疗﹢肾上腺皮质激素;治疗组：放疗﹢肾上腺皮质激素﹢申捷。申捷为每日100mg,加入到生理盐水或5％葡萄糖水中静脉滴注。两组均于放疗前及放疗后2个月行颅脑MRI、MRS检查,并测定NAA/Cr和Cho/Cr值。结果：放疗结束后双颞叶NAA/Cr在对照组中明显下降（ P＝0.022）,在治疗组中无明显下降（P＝0.949）。而Cho/Cr在对照组中明显升高（P＝0.031）,在治疗组中无明显升高（P     

颅内血管周细胞瘤fMRI及病理组织学特征分析

目的回顾分析颅内血管周细胞瘤(hemangiopericytomas,HPCs)的常规和功能MR成像表现及病理组织学特点,以提高其影像诊断的准确率。方法收集7例经病理证实的颅内HPCs(intracranial hemangiopericytomas),应用3.0T MRI行常规MRI及弥散加权成像、灌注成像和MRS,分析其特征性的MR表现和组织病理学特点。结果HPCs 7例均为脑外肿瘤,可幕上、幕下及跨幕上幕下生长。病变体积均较大［平均（6.3±1.2）cm］,形态不规则,多数呈分叶状（6例）,以窄基底附着硬膜上,肿瘤内及肿瘤中央显示血管流空信号4例,囊变和坏死6例。T1WI、T2WI及T2WI-Flair均呈混杂信号,增强呈明显强化,瘤周有轻-中度水肿。DWI呈混杂高信号［ADC值（1.15±0.36）］,PWI显示瘤体实质部分呈明显高灌注,rCBV （7.52±1.93）,rCBF （8.73±1.78）,MTT(1.62±0.29)。瘤体液化坏死区呈低灌注或灌注缺失,瘤周水肿呈低灌注。MRS显示实性区域Cho峰显著增高,NAA峰明显减低或缺如,Cho/NAA及Cho/Cr比值均明显增高,MI峰及Lac峰高耸,MI /N MI(正常侧MI),Lac/Cr明显升高,未见Ala峰显示。病理组织切片显示瘤内富含鹿角状血管,将瘤细胞分割成小叶状,瘤细胞呈卵圆形,由丰富的网状纤维围绕。7例均显示CD34(+),5例EMA(-),5例PR(-),5例SMA(-),4例GFAP(-),4例S-100(-)。Ki-67≤5% 3例,≤10% 2例,≤20% 2例。结论颅内HPCs的形态学表现以及DWI、PWI和MRS均有一定特征,与病理组织学特点有一定的相关性,多种MRI技术联合应用对其诊断及鉴别有非常重要的价值。     

Proton magnetic resonance spectroscopy (MRS) of metastatic brain tumors: variations of metabolic profile

Background Spectroscopic imaging can be helpful for the noninvasive identification of parenchymal brain tumors. The objective of the present study was the characterization of the metabolic profile of intracranial metastases, based on proton magnetic resonance spectroscopy (MRS). Methods One hundred and four metastatic brain tumors were evaluated by long-echo (TR, 2000 ms; TE, 136 ms) single-voxel volume-selected proton MRS. In 83 patients the tumor fraction within the MRS voxel constituted more than 50%. Results Compared to normal brain, the tumors showed statistically significant decreases of N-acetylaspartate (P < 0.0001), creatine (P < 0.0001), and the [NAA]/choline-containing compounds ratio (P < 0.0001), increases of [Cho] (P < 0.0001) and the mobile lipids/[Cr] ratio (P < 0.0001) and the lactate/[Cr] ratio (P < 0.05), and the more frequent presence of [Lip] (P < 0.0001) and [Lac] (P < 0.0001) resonances. However, the majority of these differences were lost when data for patients whose tumor fraction within the MRS voxel constituted less than 50% were analyzed separately. Determination of the predominant metabolite peak on the MR spectrum [NAA, Cho, Lip] permitted us to define three general metabolic patterns of brain metastases, which, showed statistically significant associations with the size of the neoplasm (P < 0.001), type of its contrast enhancement (P < 0.01), and the extent of perilesional edema (P < 0.05). Conclusion Proton MRS can define metabolically different subsets of metastatic brain tumors, and these characteristics should be taken into consideration during the differential diagnosis of parenchymal brain lesions. The results of this study were presented in part during 64^th Annual Meeting of the Japan Neurosurgical Society, October 5–7, 2005, Yokohama, Japan     

Characterization of brain tumors by MRS,DWI and Ki-67 labeling index

Summary With the advent of fast imaging hardware and specialized software, additional non-invasive magnetic resonance characterization of tumors has become available through proton magnetic resonance spectroscopy (MRS), hemodynamic imaging and diffusion-weighted imaging (DWI). Thus, patterns could be discerned to discriminate different types of tumors and even to infer their possible evolution in time. The purpose of this study was to investigate the correlation between MRS, DWI, histopathology and Ki-67 labeling index in a large number of brain tumors. Localized proton spectra were obtained in 47 patients with brain tumors who subsequently underwent surgery (biopsy or tumor removal). We performed MRS with short echo-time (30ms) and metabolic values in spectra were measured using an external software with 25 peaks. In all patients who had DWI, we measured apparent diffusion coefficients (ADC) in the same region of interest (ROI) where the voxel in MRS was located. In most tumors the histological diagnosis and Ki-67 labeling index had been determined on our original surgical specimen. Cho/Cr, (Lip+Mm)/Cr, NAA/(Cho+Cr) and Glx/Cr indexes in MRS allowed discriminating between low- and high-grade gliomas and metastases (MTs). Likewise, absolute ADC values differentiated low- from high-grade gliomas expressed by Ki-67 labeling index. A novel finding was that high Glx/Cr in vivo MRS index (similar to other known indexes) was a good predictor of tumor grading.     

大脑胶质瘤病的MRI及MRS研究(英文)

目的回顾性分析大脑胶质瘤病磁共振成像(MRI)及磁共振波谱(MRS)特点,以探讨其对本病诊断的临床价值。方法综合7例患者的临床表现、影像学特点及病理诊断,均符合大脑胶质瘤病诊断标准。常规行 SE 序列平扫及增强。其中3例行 MRS 研究,二维多体素、点分辨法(PRESS)、TE 144ms。结果所有病例均侵犯2个脑叶或以上。病变区呈长 T_2、稍长 T_1异常信号,受累区脑组织肿胀,占位效应轻。增强扫描3例见小结节或片状强化,4例无明显强化。3例 MRS 表现均有不同程度 NAA 降低,Cho 上升,Cho/Cr 和 Cho/NAA 的比值上升。结论 MRI 是目前诊断大脑胶质瘤病的首选影像学方法,MRS 对于鉴别诊断有较大价值。     

大脑胶质瘤病的MRI及MRS研究

目的回顾性分析大脑胶质瘤病磁共振成像(MRI)及磁共振波谱(MRS)特点,以探讨其对本病诊断的临床价值。方法综合7例患者的临床表现、影像学特点及病理诊断,均符合大脑胶质瘤病诊断标准。常规行SE序列平扫及增强。其中3例行MRS研究,二维多体素、点分辨法(PRESS)、TE144ms。结果所有病例均侵犯2个脑叶或以上。病变区呈长T2、稍长T1异常信号,受累区脑组织肿胀,占位效应轻。增强扫描3例见小结节或片状强化,4例无明显强化。3例MRS表现均有不同程度NAA降低,Cho上升,Cho/Cr和Cho/NAA的比值上升。结论MRI是目前诊断大脑胶质瘤病的首选影像学方法,MRS对于鉴别诊断有较大价值。