~1H-MRS在颅脑常见肿瘤诊断中的临床应用研究

目的评估氢质子磁共振波谱(~1H-MRS)在颅脑常见肿瘤诊断及鉴别诊断中的应用价值。方法分析经手术病理证实的61例颅内高级别胶质瘤、转移瘤及脑膜瘤三组病例~1H-MRS特点,并测量所有病例的瘤核心、瘤周水肿区、对侧正常脑白质感兴趣区的胆碱(Cho)、乙酰天门冬氨酸(NAA)、肌酸(Cr)代谢产物的峰值,计算Cho/NAA、Cho/Cr、NAA/Cr三种参数的比值,分别比较三组病例各参数之间的差异。结果三类肿瘤瘤核心及胶质瘤瘤旁水肿Cho/Cr、Cho/NAA均大于对侧正常脑白质(P0.01),NAA/Cr均小于对侧正常脑白质(P0.01),脑膜瘤瘤核心NAA/Cr比胶质瘤、转移瘤明显减低(P0.01),Cho/NAA比胶质瘤、转移瘤明显增高(P0.01);胶质瘤瘤旁区Cho/Cr、Cho/NAA比脑膜瘤、转移瘤明显增高(P0.01),NAA/Cr比脑膜瘤、转移瘤明显减低(P0.01)。结论作为常规MRI的有力补充,瘤核心及瘤周水肿区的~1H-MRS对颅内胶质瘤、脑膜瘤及转移瘤的诊断及鉴别诊断具有积极的临床意义。

Clinical Study of 1H-MRS in the Diagnosis of Cerebral Neoplasms

Objective To explore the value of 1H-MRS in the diagnosis and differential diagnosis of different intracranial neoplasms.Methods MRI and H-MRS was performed in 61 patients confimed to be high grade glioma,meningioma and solitary metastases.For each case,the NAA,Cr and Cho was measured in enhanced region,peritumoral region and contralateral normal-appearing white matter (CNAWM),the Cho/NAA,Cho/Cr,NAA/Cr was calculated and compared among three ROIs respectively.Results Compare to the normal region,the Cho/Cr,Cho/NAA in enhanced region of three lesions and peritumoral of glioma were higher (P＜0.01),NAA/Cr were lower (P＜0.01).In enhanced region,NAA/Cr in meningioma was lower than glioma and metastases (P＜0.01) and Cho/NAA was higher than them (P＜0.01).In peritumoral region,Cho/Cr,Cho/NAA in glioma were higher than meningioma and metastases(P＜0.01) and NAA/Cr was lower than them(P＜0.01).Conclusion As a supplement of routine MRI,1H-MRS plays an important role in the differential diagnosis of different intracranial neoplasms.