多模态影像技术在胶质瘤复发与放射性坏死鉴别诊断中的价值

目的 探讨多模态影像技术在脑胶质瘤复发和放射性坏死鉴别诊断中的应用价值。方法 回顾性分析2016年6月至2021年12月手术治疗并经术后病理检查确诊的45例胶质瘤的临床资料。以二次手术或穿刺活检病理检查结果作为诊断胶质瘤复发和放射性坏死的金标准。术后3~6个月，灌注加权成像（PWI）检测相对脑血容量（rCBV），弥散成像（DWI）检测表观弥散系数（ADC），磁共振波谱（MRS）检测N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）等参数并计算Cho/NAA、Cho/Cr比值，PET-CT检测标准摄取值（SUV）。结果 45例中，胶质瘤复发34例（复发组），放射性坏死11例（坏死组）。复发组rCBV、SUV、Cho/NAA值明显大于坏死组（P<0.05），而ADC值明显小于坏死组（P<0.05）；两组Cho/Cr值无统计学差异（P>0.05）。ROC曲线分析显示，rCBV、ADC、Cho/NAA、Cho/Cr、SUV均具有鉴别价值，其中rCBV效果最佳（P<0.05）；而Cho/Cr无明显鉴别意义（P>0.05）。rCBV、ADC、Cho/NAA、Cho/Cr、SUV联合鉴别的敏感度、特异度分别为99%和100%，明显优于单一指标（P<0.01）。结论单纯应用MRI或PET-CT某一序列或单一检查手段鉴别胶质瘤复发与放射性坏死具有一定局限性，联合应用PWI、DWI、MRS、PET-CT，可显著提高鉴别诊断准确率，对制定个体化治疗方案具有重要临床意义。     

联合应用MRS和DWI对胶质瘤级别及侵袭性进行临床评估

目的探讨应用氢质子磁共振波谱成像(1H-MRS)和弥散加权成像(DWI)对判别胶质瘤级别和侵袭性的价值,为临床评估胶质瘤生物学特性并制定手术方案提供影像学支持。方法回顾性分析27例幕上胶质瘤病人的临床资料,术前行常规MRI、MRS和DWI检查,比较正常脑组织、高级别胶质瘤与低级别胶质瘤间胆碱与乙酰天门冬氨酸的比值(Cho/NAA)及胆碱与肌酸(Cho/Cr)比值、表观弥散系数(ADC)、Ki-67标记指数(Ki-67 IL)的差异性,并分析ADC与Ki-67 IL的相关性。结果与正常脑组织对比,高级别胶质瘤中Cho/NAA及Cho/Cr比值显著升高,ADC值降低(均P0.01)。与低级别胶质瘤比较,高级别胶质瘤肿瘤中Cho/NAA及Cho/Cr比值升高,ADC值降低,Ki-67 IL升高(均P0.05)。与正常脑组织比较,低级别胶质瘤中Cho/NAA、Cho/Cr值升高(均P0.05)。在高级别胶质瘤中,Ki-67 IL与ADC值负相关(r=-0.683,P0.05);而在低级别胶质瘤中,Ki-67 IL与ADC值无相关性(r=0.187,P0.05)。结论 MRS联合DWI能够在术前评价胶质瘤的恶性程度及瘤细胞侵袭性,对胶质瘤手术治疗有重要意义。     

磁共振表观弥散系数及多体素磁共振波谱与脑胶质瘤增殖活性的相关性研究

目的探讨磁共振弥散加权成像(DWI)的表观弥散系数(ADC)值及多体素氢质子磁共振波谱(1H-MRS)所示代谢物比值与不同级别胶质瘤增殖活性的相关性及其应用价值。方法 2009年12月至2011年9月术前行DWI及多体素1H-MRS检查、术后病理学结果为脑胶质瘤病人40例,按照WHO标准分为低级别胶质瘤组(Ⅰ~Ⅱ级)与高级别胶质瘤组(Ⅲ~Ⅳ级),各20例;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)比值(NAA/Cr、Cho/Cr、NAA/Cho)及ADC值、相对ADC(rADC)值在不同级别胶质瘤的变化及其与在相应肿瘤组织中Ki-67表达的相关性。结果高级别胶质瘤组Ki-67表达水平、Cho/Cr比值明显高于低级别胶质瘤组(P<0.01),而其ADC值、rADC值、NAA/Cr比值和NAA/Cho比值则明显低于低级别胶质瘤组(P<0.01)。相关分析表明,Cho/Cr值与Ki-67标记指数呈正相关(r=0.849,P<0.01);而NAA/Cho与NAA/Cr比值、ADC和rADC值均与Ki-67标记指数呈负相关(r分别为-0.944、-0.919、-0.935和-0.938,P<0.01)。结论多体素1H-MRS及DWI检查均能有效反应脑胶质瘤的增殖活性,其中瘤体的NAA/Cho比值的诊断价值最高,其联合瘤体的rADC值筛检可大幅提升MR对胶质瘤细胞增殖活性的诊断敏感性。     

急性脑梗死患者脑组织磁共振波谱研究

目的研究基底节区急性脑梗死患者脑组织磁共振波谱(MRS)的改变。方法应用MRS检测50例一侧基底节区梗死患者(脑梗死组)及50例其他疾病患者(对照组)双侧基底节区的N-乙酰天冬氨酸(NAA)、胆碱复合物(Cho)、肌酸复合物(Cr)和乳酸(Lac)水平及NAA/Cr、Cho/Cr比值。结果脑梗死组病灶侧Cho及Cr水平均显著低于非病灶侧(均P<0.05),NAA、Lac水平及NAA/Cr、Cho/Cr比值的差异无统计学意义。脑梗死组病灶侧及非病灶侧Cho、NAA及Cr水平均明显低于对照组病灶对应区(P<0.001～0.05),而Lac水平明显高于对照组病灶对应区(均P<0.05)。与对照组病灶对应区比较,脑梗死组病灶侧Cho/Cr比值显著升高,非病灶侧NAA/Cr比值显著降低(均P<0.05)。结论基底节区梗死急性期病灶侧及对侧脑组织均有明显的代谢障碍,且病灶区代谢异常较对侧更明显。     

超高场强磁共振波谱分析对轻微型肝性脑病

目的： 研究MRS对轻微型肝性脑病(MHE)患者的诊断价值。方法　应用3.0 MR机对33例MHE患者和46例没有轻微型肝性脑病的肝硬化患者进行了扣带回和右侧前额叶的单体素点分辨自旋回波波谱序列扫描。计算N-乙酰天门冬氨酸(NAA)、肌酐(Cr)、胆碱(Cho)、肌醇(MI)和谷氨酰胺复合物(Glx)的峰下面积,计算NAA/Cr、Cho/Cr、MI/Cr、Glx/Cr,并与30例健康体检者（正常对照组）比较。33例在 MR检查前后一周内进行了静脉血氨水平测定。结果：与正常对照组相比,有轻微肝性脑病患者扣带回和右侧前额叶的Cho/Cr、MI/Cr 显著降低（P<0.01和 P0.05）,没有轻微肝性脑病的肝硬化患者与正常对照组比较MI/Cr有显著性差异（P0.05）。扣带回与右侧额叶的Glx/Cr比值与血氨浓度呈正相关,Cho/Cr 和MI/Cr的比值与血氨浓度呈负相关。 结论：MHE患者MRS检查显示扣带回和右侧前额叶Cho、MI水平降低,Glx水平升高;扣带回与右侧额叶的MRS指标与血氨之间存在相关关系,MRS对MHE的诊断有显著价值;扣带回和额叶可作为检测肝硬化患者脑改变的一个敏感部位。     

扩散峰度成像鉴别诊断高级别胶质瘤与脑转移瘤的临床价值

目的 探讨扩散峰度成像（DKI）鉴别诊断高级别胶质瘤（HGG）和单发脑转移瘤（BM）的临床应用价值。方法 回顾性分析2017年3月至2018年12月收治的23例HGG和19例单发BM的临床资料。所有病人均行MRI扫描及DKI扫描,分析两类肿瘤实质区和瘤周区DKI参数各向异性分数（FA）、平均扩散（MD）及平均峰度（MK）。利用ROC曲线计算敏感度、特异度及曲线下面积（AUC）。结果 HGG和单发BM病人MRI增强均显示不规则环状强化灶。HGG和单发BM实质区DKI参数FA、MD及MK值均无统计学差异（P>0.05）。与单发BM瘤周区相比,HGG瘤周区DKI参数FA和MK值更高（P<0.05）,MD值更低（P<0.05）。与DKI参数FA和MD值相比,瘤周区MK值鉴别HGG和单发BM的特异性与灵敏度更高,AUC更大。结论 瘤周区DKI参数FA、MD及MK值在HGG和单发BM鉴别诊断中具有重要的临床价值,且瘤周区MK值的诊断效能更高。     

MRS及DWI在脑胶质瘤中的应用价值

目的 探讨磁共振扩散加权成像（DWI）和1H-磁共振波谱（1H -MRS）在诊断脑胶质瘤及评价其分级中的作用.方法 选取80例脑胶质瘤患者进行DWI及MRS检查,通过测定脑肿瘤实质部分、对照正常侧的ADC值及比值（rADC）、N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（cr）水平及其比值,结合患者术后病理学检查结果,分析磁共振扩散加权成像（DWI）表观弥散系数（ADC）值和1H -磁共振波谱（1H -MRS）在诊断脑胶质瘤及其分级中的作用.结果 （1）高级别组患者ADC值与rADC值均显著低于低级别组,相关分析发现ADC值与rADC值与肿瘤级别呈负相关;（2）与低级别组相比,高级别组患者NAA/Cho、NAA/Cr显著降低,Cho/Cr值显著升高,差异有统计学意义（P＜0.05）.相关分析显示NAA/Cho、NAA/Cr与肿瘤级别呈负相关,Cho/Cr与肿瘤级别呈正相关.结论 通过检测rADC值、NAA/Cho、NAA/Cr、Cho/Cr的变化,可以评价低级别及高级别的脑胶质瘤,为术前分级提供重要的指导.     

针药治疗抑郁症过程中患者海马、额叶代谢的变化

目的：对正常志愿者、抑郁症患者脑海马、前额叶进行1H-MRS分析,探讨治疗前后脑内代谢物质的变化特点。方法：将75例轻、中度抑郁症患者随机分为西药组（A组）、电针组（B组）、针药组（C组）,采用GE EXCITE II Signa 3.0T磁共振系统,PROBE-J序列进行单体素采集,感兴趣区分别置于左、右两侧海马和额叶。比较正常志愿者与3组患者治疗前后N－乙酰天门冬氨酸/胆碱（NAA/Cho）、N－乙酰天门冬氨酸/肌酸（NAA/Cr）和胆碱/肌酸（Cho/ Cr）值的差异。结果：治疗前三组患者双侧海马的NAA/Cr值较对照组减低,治疗后B组双侧海马、C组右侧海马的NAA/Cr值较治疗前增高（P<0.05）,C组左侧海马的NAA/Cr值较治疗前明显增高（P<0.01）。治疗前三组患者双侧额叶的Cho/ Cr值较对照组增高（P<0.05）,治疗后A组、B组双侧额叶的Cho/ Cr值较治疗前减低（P<0.05）,C组双侧额叶的Cho/ Cr值较治疗前明显减低（P<0.01）。结论：抑郁症患者双侧额叶、海马与正常成人相应部位的代谢物浓度存在差异,三种方案干预前后抑郁症患者脑功能活动各项指标的改变表明电针可通过多途径改善抑郁,而百优解的作用途径单一。     

磁共振波谱对原发性癫痫患者海马病变的诊断价值

目的 探讨磁共振波谱(MRS)对原发性癫痫患者海马病变的诊断价值.方法 对38例原发性癫痫患者(癫痫组)和30例健康志愿者(正常对照组进行EEG、MRI和MRS检查.采用MRS检测双侧海马N-乙酰天门冬氨酸(NAA)、肌酸复合物(Cr)和胆碱复合物(Cho)的水平.结果 正常对照组EEG、MRI、MRS检查均无异常.癫痫组EEG检查发现痫样放电30例(78.9％);MRI检查发现海马异常15例(39.5％),其中双侧异常10例、单侧异常5例;MRS检查发现海马异常35例(92.1％),其中双侧异常30例、单侧异常5例.癫痫组病侧海马Cho/Cr和Cho/NAA显著高于对侧海马及正常对照组(均P＜ 0.001),NAA/(Cho+Cr)显著低于对侧海马及正常对照组(均P＜0.001).癫痫组病侧海马头部的NAA/(Cho+ Cr)明显低于体部及尾部(均P＜0.001).结论 MRS可提高原发性癫痫患者海马病变的检出率,且可显示海马的生化改变,对原发性癫痫具有很高的诊断价值.     

首发偏执型精神分裂症全脑磁共振质子波谱分析

目的探讨未用药首发偏执型精神分裂症患者的多个兴趣区灰质的磁共振氢质子波谱分析（MRS）的特点,以期为精神分裂症“神经发育异常假说”提供依据。方法选取20例首发偏执型精神分裂症患者,应用MRS技术对11个兴趣区的白质或灰质进行脑内神经生化代谢物检测,并与20例年龄、性别和文化程度与患者相匹配的健康对照者比较。结果与对照组比较,患者组双侧额叶皮质的NAA值、Cho值和NAA/Cr、Cho/Cr比率,左侧颞叶Cho值和NAA/Cr,胼胝体膝部和左侧小脑中脚的NAA值和Cho值,右侧丘脑和双侧尾状核Cho值（P〈0.05）。结论首发偏执型精神分裂症患者脑内胼胝体膝部和左侧小脑中脚发生了弥漫性轴突损害,支持精神分裂症神经发育异常的神经病理假说。     

Combined application of MRS and DWI can effectively predict cell proliferation and assess the grade of glioma: A prospective study

In order to assess combined application of MRS and DWI for prediction cell proliferation and grade diagnosis of glioma, We prospectively collected the Cho/Cr, Cho/NAA, Cr/NAA of MRS and tumor parenchyma ADC (ADC_T), contralateral mirror brain tissue ADC (ADC_H), rADC (rADC = ADC_T/ADC_H). According to postoperative pathology, the patients were divided into two groups: LGG group and HGG group, compared differences of age, gender, Ki67, MRS, DWI between two groups. Next, we analyzed the correlation between MRS, DWI and Ki67. On this basis, the sensitivity and specificity of MRS, DWI and MRS combined with DWI (MRS + DWI) in diagnosis of glioma grade were evaluated. The differences of Ki67, Cho/Cr, Cho/NAA, Cr/NAA, ADC_T, rADC between LGG group and HGG group were statistically significant (p = 0.000, 0.000, 0.000, 0.008, 0.000, and 0.000 respectively). From ROC curve, area under the curve (AUC), sensitivity and specificity of Cho/Cr, Cho/NAA, Cr/NAA, ADC_T, rADC, PRE (MRS + DWI) were (0.901, 86.7%, 85.7%), (0.876, 80.0%, 82.1%), (0.704, 63.3%, 71.4%), (0.862, 82.1%, 83.3%), (0.820, 75.0%, 76.7%), (0.920, 86.7%, 89.3%), respectively. Fisher's linear discriminant functions results suggest: Y₁ = -20.447 + 3.46•X₁ + 17.141•X₂ (LGG), Y₂ = -19.415 + 4.828•X₁ + 14.543•X₂ (HGG). Our study suggested that MRS and DWI can effectively predict cell proliferation preoperative. MRS combined with DWI can further improve sensitivity and specificity in assessing the grade of glioma.     

The utility of magnetic resonance spectroscopy in frame-less stereotactic needle biopsy of glioma

ObjectiveProton magnetic resonance spectroscopy (¹H—MRS) can benefit the differentiation of gliomas preoperative grading and facilitate guiding biopsy. This study was to investigate the optimal metabolite or metabolic ratios of MRS for the biopsy target delineating by using the technique of MRS imaging guided frame-less stereotactic biopsy.MethodsDuring a 4 year period between the Sep 2012 and Oct 2016, 57 patients (25 women, 32 men; mean age, 46.4) with histologic diagnosis of glioma, who underwent the ¹H—MRS imaging guided frameless stereotactic biopsy, were retrospectively reviewed. The metabolite or metabolic ratios values of MRS was measured. And the sensitivity, specificity, accuracy as well as the area under the curve (AUC) of those parameters for glioma grading are calculated based on the receiver operating characteristic curve (ROC) analysis.Results65 stereotactic biopsy samples from 57 patients were histopathologically clarified to HGGs (25) or LGGs (40) for quantitative analysis. The Cho, Cho/NAA and Cho/Cr values of LGGs group were significantly lower than that of HGGs (P = 0.09, 0.001, 0.003), and the NAA value of LGGs group was significantly higher than that of HGGs (P = 0.001). The cutoff value of 3.65 for the Cho/NAA ratio provided the best combination of sensitivity (92.0%), specificity (95.0%), and diagnostic accuracy (93.8%) for identifying glioma grade, which was superior to other parameters.ConclusionThe results of our study provided evidence that Cho/NAA ratio had the superior diagnostic performance in distinguishing glioma grade, indicating that the spot of highest Cho/NAA ratio was optimal metabolic targets for spectroscopic guided tissue sampling in homogenous glioma.     

Brain metabolic disorders after chemotherapy in the study by magnetic resonance spectroscopy

The purpose of our study was to evaluate CNS pathology due to chemotherapy neurotoxicity, using MRI and localized proton MRS in patients with lung cancer treated with cisplatine, Vinca alkaloids and etoposide. A reduction in N-acetylaspartate was expected as a result of chemotherapy neurotoxicity. METHODS: 31 patients aged 42 to 73 years underwent the following procedures before and after chemotherapy: clinical examination; MRI of the brain (Elscint Prestige 2T), MRS (PRESS sequence, TR 1500 ms, TE 80 ms) with volumes of interest (VOI) of 8 ml localized in the semi-oval center and a cerebellar hemisphere. The analysis of each patient's NAA/Cr and Cho/Cr ratios was carried out separately for the semi-oval center and cerebellum measurements. RESULTS: None of the patients demonstrated any clinical manifestations of the CNS neuropathy. MRI of the brain did not reveal any abnormalities caused by chemotherapy. Pre-treatment NAA/Cr and Cho/Cr ratios in the semi-oval center did not differ significantly from these measured after chemotherapy. However, the analysis of the cerebellar spectra showed a significant decrease in the NAA/Cr ratio (p < 0.05) and a time-related decrease in the Cho/Cr ratio (p < 0.05) after chemotherapy. An analysis of Pearson's correlations showed a very strong linear relationship between NAA/Cr and Cho/Cr ratios (p < 0.001), both in the semi-oval center and cerebellum. CONCLUSION: The decreased NAA/Cr ratio can indicate some neuronal loss caused by chemotherapy. The decrease in the Cho/Cr ratio could be associated with some myelin damage. The MRS results suggest the presence of a sub-clinical selective cerebellar neuropathy caused by chemotherapy. The MRS revealed that reaction to chemotherapy was different at the semi-oval center than that in the cerebellum. The results allow theorizing about an alternative or two-stage brain response to the neurotoxic factor found both in the cerebrum (the semi-oval center) and cerebellum. These initial results indicate that proton MR spectroscopy is a potentially useful modality for detecting an early stage of the CNS pathology caused by neurotoxicity of chemotherapy.     

磁共振波谱检测肌萎缩侧索硬化的上运动神经元损害

目的探讨质子磁共振波谱(proton magnetic resonance spectroscopy,1 H-MRS)检测肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的上运动神经元损害(upper motor neuron,UMN)的特点和诊断准确性。方法收集ALS患者31例和健康对照32名,采用1 H-MRS检测脑中央前回皮质下、内囊后肢和大脑脚感兴趣区代谢产物N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)的水平,计算NAA/Cr、NAA/(Cho+Cr)、Cho/Cr比值,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析1 H-MRS对ALS患者UMN损害的诊断价值。结果 ALS患者各锥体束走行部位和部位组合的NAA/Cr和NAA/(Cho+Cr)较对照组显著降低(P0.05)。NAA比值预测ALS的UMN损害的ROC曲线下面积(area under the curve,AUC)为0.67~0.91,其中内囊后肢、大脑脚两部位的平均NAA/(Cho+Cr)和三部位的平均NAA/(Cho+Cr)的AUC、灵敏度、特异度分别为0.91、0.828、0.906和0.90、0.769、0.875。结论 1 H-MRS可检出ALS患者锥体束走行的生化代谢异常,是评估ALS的UMN损害的客观影像学指标,其诊断准确性中等,多水平检测和综合指标的选择有助于提高其诊断效力。     

Proton magnetic resonance spectroscopy of normal appearing white matter in familial and sporadic multiple sclerosis

Objective To assess metabolite levels in normal–appearing white matter in sporadic and familial multiple sclerosis (MS). Methods Using H–MRS and applying one voxel measure we assessed NAA/Cho,NAA/Cr and Cho/Cr ratios in 26 patients with sporadic and in 25 with familial MS and compared them with healthy subjects. Results In both MS groups NAA/Cho and NAA/Cr ratio were significantly lower than in healthy individuals whereas Cho/Cr ratio was higher in MS patients. In sporadic MS patients NAA/Cho and NAA/Cr ratios were lower, although not significantly, than in familial cases. The Cho/Cr ratio was similar in both MS groups. Conclusion These results suggest that subtle differences in H–MRS measures corresponding to axonal rather than to myelin pathology might occur in sporadic and familial MS.