大脑胶质瘤病磁共振成像结合磁共振波谱成像的诊断价值

目的：探讨磁共振成像（MRI）结合磁共振波谱成像（MRS）对大脑胶质瘤病的诊断价值。方法对15例经活体组织检查或手术病理证实的大脑胶质瘤病患者的临床表现及MRI平扫、增强,MRS影像学资料进行回顾性分析。MRI常规行T1WI、T2WI及FLAIR序列,采用时间飞跃法（TOF）的磁共振血管成像（MRA）,T1WI增强扫描。氢质子MRS采用单体素STEAM序列,并分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）、胆碱复合物（Cho）等物质峰值改变。结果所有病例均侵犯2个或2个以上脑叶,以颞叶、枕叶、胼胝体、基底节和丘脑等部位侵犯受累常见。病变区T1WI呈低或等低信号、T2WI呈高或混杂高信号、FLAIR上为高信号,未见明显坏死、钙化,受累区域脑组织肿胀,占位效应轻。注射钆喷酸葡胺增强扫描示10例无明显强化、3例斑片状强化、1例结节状强化、1例线状轻度强化。病变区域MRS表现为不同程度NAA降低,NAA/Cr比值降低;Cho上升,Cho/Cr和Cho/NAA的比值上升。结论 MRI结合MRS对大脑胶质瘤病的诊断及鉴别诊断具有临床价值,是目前诊断大脑胶质瘤病的首选影像学方法。     

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 ,以探讨两者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 14 4ms。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。 3例增强扫描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。     

MRI及MRS在大脑胶质瘤病诊断中的应用

目的：探讨MRI及MRS在大脑胶质瘤病诊断及鉴别诊断中的意义。方法：回顾性分析经穿刺病理或手术病理证实的5例大脑胶质瘤病患者,所有患者均行常规MRI检查及单体素MRS检查。结果：MRI常规图像显示所有病灶均呈浸润性生长但无明确肿块形成,病变累及区脑回肿胀、脑沟及脑裂变浅。5例患者均累及三个脑叶,其中同时合并单侧基底节区受累4例,合并胼胝体区受累5例。MRI常规图像所有病灶T1WI均呈弥漫性低信号,T2WI呈弥漫性高信号;增强扫描2例病灶内见斑片状强化区,所有病灶内未见明显坏死区或囊变区。MRS谱线显示5例病灶内谱线均表现为不同程度NAA峰降低,Cho峰升高,Cho/Cr比值及Cho/NAA比值升高。结论：MRI及MRS对大脑胶质瘤病的早期诊断及鉴别诊断具有重要作用。     

高级别胶质瘤和转移瘤的磁共振波谱及灌注成像研究

目的通过磁共振波谱(MRS)及灌注成像(PI)研究肿瘤强化区域、肿瘤周围区域的细胞代谢和血管分布特点,探讨MRS及PI对高级别胶质瘤和转移瘤的鉴别诊断价值。资料与方法23例颅内肿瘤患者,包括高级别胶质瘤(Ⅲ～Ⅳ级)13例,转移瘤10例,行常规MRI、PI和单体素MRS检查。MRS检查主要观察的代谢物有:氮-乙酰天门冬氨酸(NAA),胆碱(Cho),肌酸(Cr/PCr),计算NAA/Cr,Cho/Cr,NAA/Cho比值。PI观察指标为相对脑血容量(rCBV)。采用SPSS10.0软件进行统计学分析。结果MRS提示高级别胶质瘤和转移瘤肿瘤强化区域均出现NAA/Cr与NAA/Cho降低,Cho/Cr升高;两种肿瘤强化区域各项比值之间的比较差异均无统计学意义(P>0.05);高级别胶质瘤肿瘤周围组织亦出现NAA/Cr与NAA/Cho降低,Cho/Cr升高,与转移瘤肿瘤周围组织相比差异均有统计学意义(P<0.05)。高级别胶质瘤和转移瘤肿瘤强化区域的rCBV值分别为4.05±2.04,3.84±2.44,两者之间差异无统计学意义(P>0.05),肿瘤周围组织的rCBV值分别为1.31±0.14,0.56±0.22,两者之间差异有统计学意义(P<0.05)。结论结合肿瘤强化区域与肿瘤周围区域的MRS和PI,有助于提高对高级别胶质瘤和转移瘤的鉴别能力。     

MRI和MRS对前列腺疾病的鉴别诊断价值

目的探讨MRI和MRS在前列腺疾病中的鉴别诊断价值。方法回顾分析经病理证实的22例患者的临床资料及MRI和MRS所见,其中包括前列腺良性增生(BPH)16例及前列腺癌(PC)6例。MRI观察前列腺大小、病变位置、信号特点和肿瘤侵犯程度,MRS观察枸橼酸盐(Cit)、胆碱复合物(Cho)和肌酸(Cr)的化学位移及(Cho Cr)/Cit比值。结果16例BPH中,前列腺弥漫性增大,T2W均示前列腺中央叶明显增大,其中13例表现为多个大小不等类圆形高和/或低信号结节,部分低信号结节周围可见低信号假包膜,外围带受压变窄。6例PC中5例均表现为T2W外周带中见低信号区,1例表现为中央叶前部较大低信号结节;2例位于包膜内,4例突破包膜侵犯精囊腺和血管神经束,其中1例伴有盆腔淋巴结肿大和骨盆骨转移。MRS上BPH患者Cit明显升高,Cho略升高,(Cho Cr)/Cit比值不高,平均0.60。PC患者,Cit明显下降,Cho明显升高,(Cho Cr)/Cit比值升高,平均2.51。分别对PC与BPH体素的2组代谢物比值进行比较,二者之间有显著的统计学差异(t=0.353,P<0.05)。结论MRI和MRS有助于PC和BPH的鉴别诊断。     

脑室内星形细胞瘤的MRI诊断及鉴别诊断

目的 探讨脑室内星形细胞瘤的MRI表现、特点及其与脑室内其他肿瘤的鉴别诊断。资料与方法 回顾性分析经手术病理证实的12例脑室内星形细胞瘤的MRI资料。扫描序列包括：SE轴位T1WI、矢状位T1WI;FSE轴位T2WI。所有病例均行增强扫描。3例行磁共振波谱（MRS）研究,二维单体素,点分辨法（PRESS）,TE144ms。结果 脑室内星形细胞瘤的MRI表现：T1WI、T2WI多表现为不均匀信号（10／12）,囊变坏死常见（9／12）,病灶呈菜花状或乳头状（8／12）;增强后多明显强化（9／12）且不均匀（8／12）,肿瘤血管流空信号（5／12）及出血（3／12）,发生率均较发生于脑实质内的相同级别的星形细胞瘤高。所有病例均未见灶周水肿,但均可见病灶以上水平脑室积水。MRS3例均有不同程度N-乙酰天门冬氨酸（NAA）降低,胆碱（Cho）上升,Cho／肌酸（Cr）和Cho／NAA的比值上升,高于正常脑组织。结论 脑室内星形细胞瘤较少见,临床上常因认识不足而误诊。其MRI表现较脑实质内星形细胞瘤有所差异,需与脑室内的其他肿瘤相鉴别。MRS具有一定的鉴别诊断价值。     

MRI对脑胶质瘤病的诊断价值

目的：探讨MRI对脑胶质瘤病的诊断价值。方法：分析7例脑胶质瘤病的MRI表现。结果：7例胶质瘤病均侵犯2个脑叶或以上，5例侵及大脑深部结构，病变均呈长T1、长T2信号，占位效应不明显，未见明显强化，DWI示部分病灶呈高信号，ADC图呈低信号，且ADC值低于正常脑实质值，MRS波谱示病变区NAA峰明显降低，2例CHO峰明显升高，未见明显LAC峰，病理证实为脑胶质瘤病。结论：MRI是目前诊断脑胶质瘤病的首选影像学诊断方法。     

CT、MRI和MRS在原发性基底节区生殖细胞瘤中的诊断价值

目的 研究基底节区生殖细胞瘤的CT、MRI及氢质子磁共振波谱(1H-MRS)表现,以提高对该病的诊断水平.资料与方法 搜集6例经活检或手术病理证实的生殖细胞瘤,全部病例均行MRI平扫加增强扫描,其中4例加做CT平扫及增强扫描,3例行MRS检查,5例行追踪复查.对其影像学表现进行回顾分析.结果 CT表现:2例点状钙化,2例囊实性肿块.MRI表现:3例为肿块状,3例为片状(复查时示肿块状).T1WI上病灶呈低或等信号,T2WI呈高信号.增强后3例呈环状强化,2例轻度片状强化,1例显著均匀强化.3例呈片状肿瘤者行MRS检查,首诊时胆碱(chohne,Cho)、氮-乙酰天门冬氨酸(N-acetyl aspartate,NAA)、肌酸(creatine,Cr)峰的形态大致正常,2例NAA/Cho和NAA/Cr下降,并见脂质(Lip)/乳酸(Lac)峰,1例复查时Cho峰升高,NAA、Cr峰降低.结论 CT、MRI在基底节区生殖细胞瘤的诊断中具有一定的局限性,1H-MRS发现NAA/Cho、NAA/Cr比值下降和出现Lip/Lac峰,建议临床进行穿刺活检以早期诊断.     

2D CSI1H-MRS对不同类别脑肿瘤的鉴别诊断

目的 探讨二维化学位移氢质子磁共振波谱(2D CSI1H-MRS)对胶质瘤、转移瘤、脑膜瘤的鉴别诊断价值.资料与方法 回顾性分析经临床诊断或经手术病理证实的90例患者的MRI及MRS资料,包括胶质瘤45例,转移瘤23例,脑膜瘤22例.计算瘤体及瘤周水肿区的Cho、Cr、NAA的浓度及Cho/Cr、NAA/Cr、NAA/Cho的比值.结果 (1)胶质瘤、转移瘤、脑膜瘤瘤体区的NAA/Cho分别为0.41±0.19、0.56±0.15、0.15±0.07,三组差异均有统计学意义(P＜0.05);(2)胶质瘤、转移瘤、脑膜瘤瘤周水肿区的Cho浓度分别为0.40 ±0.16、0.26±0.09、0.13±0.07,3组差异均有显著统计学意义(P＜0.01),胶质瘤显著高于其他两者,当取Cho＞0.45时,MRS区分胶质瘤的特异性、敏感性、阳性预测值、阴性预测值分别为83%、94%、77.3%、85.7%.结论 2D CSI1H-MRS对胶质瘤、转移瘤、脑膜瘤的鉴别诊断有重要意义.     

磁共振波谱成像对颅脑肿瘤的鉴别诊断价值

目的:分析脑肿瘤的氢质子磁共振波谱成像(1H-MRSI)改变,评价1H-MRSI对颅内常见肿瘤的诊断和鉴别诊断价值.方法:本组共42例颅内肿瘤患者行1H-MRSI检查,其中胶质瘤17例、脑膜瘤14例、脑转移瘤11例.测量比较3种肿瘤的实质强化区、周围水肿区和对侧正常脑组织的代谢物浓度(包括N-乙酰天门冬氨酸、肌酸和胆碱)并进行分析比较.结果:常规MRI检查T1WI上肿瘤多为等、低信号,T2WI上呈不均匀高信号,伴有不同程度强化和周围水肿.脑肿瘤的主要MRS袁现为NAA/Cho、NAA/Cr下降,Cho/Cr升高;3纽肿瘤周围水肿区的NAA/Cho分别为1.0167±0.314,1.4250±0.326和2.2900±1.186,组间比较差异均有显著性意义(P＜0.05);其它代谢物指标(NAA/Cr和Cho/Cr)在3种肿瘤间的差异无显著性意义(P＞0.05).3组肿瘤实质强化区各代谢物比值间差异无显著性意义(P＞0.05).结论:1H-MRSI可无创地分析脑肿瘤的代谢状况,对脑肿瘤的诊断、鉴别诊断均有很大的价值.     

Value of diagnosis and differential diagnosis of MRI and MR spectroscopy in gliomatosis cerebri

PURPOSE: The purpose of this study was to characterize gliomatosis cerebri on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), and to analyze the value of these two techniques in diagnosis and differential diagnosis of gliomatosis cerebri. MATERIALS AND METHODS: MR images of 14 patients with gliomatosis cerebri were reviewed retrospectively; seven of the patients also underwent MRS (single-voxel point-resolved spectroscopy, and chemical-shift imaging point-resolved spectroscopy). Tumorous were confirmed by surgery and biopsy. The distribution, extension and signal features of lesions were assessed, and the MR spectroscopy results were analyzed. RESULTS: Tumors involved at least two lobes of the brain in all patients. Widespread invasion with isointensity or hypointensity on T1-weighted MR images and hyperintensity on T2-weighted images were found while no prominent necrosis, hemorrhage or contrast enhancement was found. All patients who underwent MRS showed elevated Cho/Cr and Cho/NAA levels as well as decreased NAA/Cr ratios in the abnormal areas on T2-weighted images, three of which showed a lactate doublet. Anaplastic lesions had higher Cho/NAA levels in three cases. Abnormality of metabolism was also seen in the margin of the lesion that was normal on T2-weighted images. CONCLUSION: MRI and MRS are valuable techniques for diagnosis and differential diagnosis of gliomatosis cerebri. Combining clinical information and MRI findings, as well as MRS, is crucial for making a definitive diagnosis.     

Multivoxel magnetic resonance spectroscopy in gliomatosis cerebri

Gliomatosis cerebri is a rare entity with non-specific clinical and conventional magnetic resonance imaging (MRI) findings; accurate diagnosis is a differential diagnostic challenge. MR spectroscopy has recently been introduced as a useful diagnostic tool for detection of this entity. We present a gliomatosis cerebri case in which we made the radiological diagnosis using the MR spectroscopy findings; the diagnosis was confirmed by subsequent biopsy and histopathologic evaluation. Multivoxel spectroscopy (CSI, PRESS, 1500/135) shows a marked increase in Cho/NAA (6.6), normal to mild increase in Cho/Cr (1.2), and marked decrease in NAA/Cr (0.2) compared with the normally appearing contralateral side (Cho/NAA: 0.8, Cho/Cr: 0.9, NAA/Cr: 1.2).     

鞍旁海绵状血管瘤的CT和MRI诊断

目的总结7例鞍旁海绵状血管瘤CT、MRI和磁共振波谱（MRS）表现,探讨其诊断和鉴别诊断。资料与方法7例均经手术病理证实,均行CT和MR平扫,2例行CT增强扫描,7例行MR增强扫描,5例行MR扩散加权成像（DWI）,6例行^1H MRS检查。结果鞍旁海绵状血管瘤体积大,并同时伸入到鞍内。CT平扫病变呈等或稍高密度,密度均匀,MR T1WI呈等或稍低于脑灰质信号,T2WI呈类似脑脊液高信号。增强扫描病变呈非常显著强化。DWI呈等或稍低信号,但表观扩散系数（ADC）值明显高于正常脑实质。。HMRS表现为NAA峰、Cr峰和Cho峰消失。可出现Lip峰。结论CT检查时鞍旁海绵状血管瘤与脑膜瘤和垂体瘤鉴别困难,MRI表现很有特点,T2WI呈极高信号,增强扫描非常显著强化,ADC值明显升高而DWI接近等信号,MRS检查无NAA峰、Cr峰和Cho峰,MRI可以对海绵窦海绵状血管瘤作出定性诊断。     

MR spectroscopy in gliomatosis cerebri

BACKGROUND AND PURPOSE: The diagnosis of gliomatosis cerebri with MR imaging is known to be difficult. We report on the value of MR spectroscopy in the diagnosis, grading, and biopsy planing in eight patients with histopathologically proved gliomatosis cerebri. METHODS: Patients underwent MR imaging and MR spectroscopy (single-voxel point-resolved spectroscopy [PRESS] at 1500/135, and chemical-shift imaging [CSI] PRESS at 1500/135) before open (n = 4) or stereotactic (n = 4) biopsy. In six patients who underwent CSI, biopsy samples were taken from regions of maximally elevated levels of choline/N-acetylaspartate (Cho/NAA). RESULTS: All patients showed elevated Cho/creatine (Cr) and Cho/NAA levels as well as varying degrees of decreased NAA/Cr ratios, which were most pronounced in the anaplastic lesions. In low-grade lesions, there was a maximum Cho/NAA ratio of 1.3, whereas in anaplastic tumors, the maximum Cho/NAA level was at least 2.5. Spectra in two patients with grade III lesions revealed a lactate peak; lactate and lipid signals were seen in two patients with grade IV lesions. Biopsy specimens from regions with maximally elevated levels of Cho/NAA showed dense infiltration of tumor cells. CONCLUSION: MR spectroscopy might be used to classify gliomatosis cerebri as a stable or a progressive disease indicating its potential therapeutic relevance.     

颅内血管外皮细胞瘤的MRI及MRS诊断

目的:探讨颅内血管外皮细胞瘤的MRI及MRS表现特征. 材料和方法:回顾性分析7例颅内血管外皮细胞瘤的MRI、MRS表现,其中MRI检查7例,MRS检查4例. 结果:7例中,肿块呈多分叶状6例,MRI平扫中3例T1WI呈等信号,3例呈等、低信号,1例合并出血肿块内夹杂高信号灶,T2WI上2例呈等信号,4例呈等高混杂信号,1例呈混杂高信号,5个肿块内及周边均可见多发迂曲扩张的血管流空影,增强扫描肿块明显均匀(3例)或不均匀(4例)增强.4例MRS均表现为Cho明显升高及明显高耸Lip峰,NAA明显降低或消失,2例MI峰明显增高,未见Ala峰和Glx峰.结论:颅内血管外皮细胞瘤MRI表现具有一定特征性,结合MRS表现有助于与脑膜瘤的鉴别.