单体素和多体素MRS在胶质瘤诊治中的优缺点

磁共振波谱是唯一能无创伤性的在体检测组织生化代谢的技术方法。磁共振波谱可分为单体素波谱和多体素波谱。单体素波谱操作简单、检查时间较短，还可以获得较好的匀场效果和波谱图像，但是体素较大。体素定位的准确性非常重要。多体素波谱体素小、视野较大，可同时反映不同代谢物的空间分布。但操作较复杂，检查时间较长。本文主要对单体素波谱和多体素波谱的优缺点及其在胶质瘤中的应用加以总结。     

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。     

质子磁共振波谱在脑胶质瘤中的临床应用

质子磁共振波谱(HMRS)是研究人体器官、组织代谢、生化改变及化合物定量分析的惟一无创方法,对脑胶质瘤的诊断、分级、鉴别诊断、放射治疗靶区勾画及预后评价具有重要作用.     

着丝粒蛋白F在脑胶质瘤中的表达及其意义

目的：检测着丝粒蛋白F（CENP—F）在脑胶质瘤中的表达，探讨其临床意义。方法：采用免疫组化方法检测64例脑胶质瘤和10例正常脑组织石蜡包埋标本中CENP—F的表达。结果：CENP—F在64例脑胶质瘤中表达阳性率为76．6％．在10例正常脑组织中仅30．0％，差异有统计学意义（P〈0．01）。CENP—F的表达在不同性别、年龄、肿瘤部位、肿瘤直径、瘤周水肿及病理分类中差异无统计学意义（P〉0．05），在不同病理分级中差异有统计学意义（P〈0．05），高分级组较低分级组表达高。结论：CENP—F在脑胶质瘤中高表达，与肿瘤病理分级有关，对判断脑胶质瘤生物学特性有一定意义。     

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。     

血管生成抑制素对C6脑胶质瘤的抑瘤效应

目的探讨不同剂量的血管生成抑制素（Angiostatin）在胶质瘤治疗中的抑制血管生成作用。方法应用不同剂量（100ng、1000ng）的血管生成抑制素分别作用于体外培养的大鼠C6脑胶质瘤细胞系和C6/SD大鼠脑胶质瘤模型,分别计算细胞存活率和抑瘤生成率,SABC免疫组织化学技术检测体内胶质瘤中的微血管密度。结果不同剂量的血管生成抑制素均对体外培养的胶质瘤细胞的生长不产生明显抑制作用;对体内生长的胶质瘤则有显著抑制作用,而且较高剂量的Angiostatin的抑制作用更为明显,抑瘤率最高达65.3％（P<0.01）。经不同剂量的血管生成抑制素处理的脑胶质瘤中微血管密度较对照组降低（P<0.01）。结论血管生成抑制素能抑制C6脑胶质瘤的血管生成,且较高剂量实验组的作用更为明显,此研究对血管生成抑制素抑制C6胶质瘤的生长机制研究奠定了一定基础。     

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。     

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。     

磁共振灌注加权成像和扩散张量成像对脑胶质瘤患者的分级诊断效果

目的探讨磁共振灌注加权成像(PWI)和扩散张量成像(DTI)对脑胶质瘤患者的分级诊断效果。方法回顾性分析2010年1月至2014年6月间接受治疗的80例脑胶质瘤患者,经手术与病理学证实的高级别与低级别患者各40例,对比分析高低级别患者术前磁共振PWI和DTI的检查指标,根据受试者工作特征(ROC)曲线确定诊断阀值、计算敏感度和特异度。结果脑胶质瘤瘤体、瘤周及正常区间的表观扩散系数(ADC)、各向异性分数(FA)、局部脑血流量(r CBF)、局部脑血容量(r CBV)量化值的差异均有统计学意义(P<0.05);高、低级别脑胶质瘤瘤体的相对ADC(r ADC)、相对r CBF(rr CBF)、相对r CBV(rr CBV)量化值差异有统计学意义(P<0.05);脑胶质瘤瘤体ADC、rr CBF、rr CBV的AUC值均>0.9,且敏感度与特异度都很高。结论脑胶质瘤瘤体的ADC、rr CBF及rr CBV的诊断敏感度和特异度都很高;在脑胶质瘤分级诊断的过程中,脑胶质瘤瘤体的ADC、r CBF及r CBV可以作为理想的量化指标。     

多模态MRI在高级别脑胶质瘤放疗中的应用

放疗是高级别脑胶质瘤治疗的重要手段之一。目前,对于利用定位CT和常规MRI图像进行靶区勾画的范围仍然没有统一标准。随着影像学技术的不断发展,研究者们发现利用多模态MRI包括氢质子磁共振波谱分析(¹H-MRS)、BOLD-fMRI (血氧水平依赖性功能磁共振)、弥散加权成像(DWI)、弥散张量成像(DTI)等可更有效地评估肿瘤的浸润范围及定位周围重要组织,从而作为一种补充手段应用于靶区勾画和保护危及器官之中。此外,多模态MRI对评估放疗疗效、探测放射损伤及鉴别真假性进展也有一定作用。文章就多模态MRI在高级别脑胶质瘤术后放疗中应用作一综述。     

胶质瘤的MR影像学研究进展

胶质瘤是颅内最常见的原发性肿瘤。近年来，随着影像学技术的进步，胶质瘤的诊断由既往单纯形态学水平，深入到分子水平。本文介绍MR灌注成像（perfusion weighted imaging，PWI）、磁共振弥散加权成像（diffusion weighted imaging，DWI）与弥散张量成像（diffusion tensor imaging，DTI）、磁共振波谱（magnetic resonance spectroscopy，MRS）、功能磁共振（functional MRI，fMRI）等新技术在胶质瘤诊断上的应用。这砦新的进展对于胶质瘤的诊断与鉴别诊断，明确肿瘤级别，疗效监测及判断预后等具有重要意义。     

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.     

Investigation of Genetic Alterations Associated with Development and Adverse Outcome in Patients with Astrocytic Tumor

Models describing progression in the genetic derangement of glial tumors have shown chromosomal loss and gain occurring most frequently in high-grade lesions, suggesting that identification of these aberrations may be prognostically significant. In this study, Fluorescence in situ hybridization (FISH) has been used to determine, and to confirm, loss and gain of chromosomes 1, 8, 10, 12 and 17, in formalin-fixed, paraffin-embedded brain biopsy tissue taken from 60 brain gliomas submitted to surgical resection or stereotactic biopsy. FISH analysis may be a valuable adjunct to histological grading. The results showed that this molecular cytogenetic technique is an important clinical and experimental tool that provides new insight on genetic alterations, confirming gain and loss of genetic material that occurs at the initiation and progression of human glioma. Our data suggests that potentially useful prognostic information may be obtained through this approach. Monosomy 10 was the most statistically significant negative predictor of patient survival, showing a significant correlation with the histological grading.     

胶质瘤恶性程度分级的功能性磁共振成像研究进展

胶质细胞瘤是最常见的颅内恶性肿瘤,其生长特点为浸润性生长,与正常脑组织无明显界限,偏良性者生长缓慢,病程较长,恶性者瘤体生长快,病程短。因此,对于临床治疗而言,胶质瘤的准确分级是非常必要的。目前,随着影像学技术的快速发展,功能磁共振成像不仅可为临床提供精细解剖信息,还可以提供肿瘤功能及代谢等方面的信息。因此,该文综述了扩散加权成像（DWI）、磁共振波谱成像（MRS）、扩散张量成像（DTI）、灌注加权成像（PWI）、磁敏感加权成像（SWI）等功能MRI技术在胶质瘤恶性程度分级诊断中的应用,从而更准确地指导临床个体化治疗。     

The contribution of Magnetic Resonance Spectroscopy and echoplanar perfusion-weighted MRI in the initial assessment of brain tumours

Summary Conventional Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are the cornerstone in the initial evaluation of brain tumours. The purpose of this study is to evaluate the contribution of Magnetic Resonance Spectroscopy (MRS) and Perfusion-weighted MRI to distinguish malignant from benign tumours.We included 55 patients diagnosed with single brain tumour by CT and MRI, and final histopathological verification of the tumour type: 25 were low-grade gliomas, 8 anaplastic gliomas, 11 glioblastomas, and 11 solitary metastases. We carried out brain MRS and dynamic perfusion-weighted echoplanar MRI in all cases. Perfusion was assessed in the centre of the lesion and in the area of maximum contrast-enhancement.In MRS, we found significant differences in Choline/Creatine ratios in relation to the tumour type with the highest values in high-grade gliomas and metastases. A Ch/Cr ratio equal or higher than 1.78 predicted malignancy at 80% sensitivity and 73% specificity. We found no significant differences in the relative cerebral blood volume (rCBV) for every type of tumour. The mean rCBV was 1.24 for benign tumours and 1.5 for the malignant ones(1.24 for low-grade gliomas, 1.91 for anaplastic gliomas, 1.03 for glioblastomas, and 1.57 for metastases).We conclude that, individually considered, MRS is superior to Perfusion-weighted MRI in the initial assessment of brain tumours. Perfsion MRI has not demonstrated predictive power to distinguish malignant from benign tumours.     

MRS与脑胶质瘤代谢边界的相关性研究

MRS通过检测活体组织器官能量代谢、生化改变以及化合物定量分析,可以较早地探测到脑胶质瘤周围组织代谢异常,精确判定肿瘤的浸润范围,相比常规MRI结构成像更逼近实际的脑胶质瘤组织病理学边界。MRS为脑胶质瘤边界的综合判定提供更为科学、客观和敏感的依据,为手术或放、化疗方案的制订提供有价值的信息。     

In vitro and in vivo MRS study of human glioma metabolites

In this study an in vitro multinuclear magnetic resonance spectroscopy (MRS) characterization of water soluble metabolites and of the lipid fraction obtained from 19 human gliomas (12 glioblastomas, 3 anaplastic astrocytomas, 2 anaplastic oligodendrogliomas and 2 oligodendrogliomas) with a total of 27 surgical specimens, is reported. Moreover, some in vivo H-1 MRS results are shown. The regional metabolic heterogeneity of glioblastomas, according to their morphological heterogeneity, is documented. For glioblastomas a specific in vitro H-1 MRS metabolite profile cannot be defined. Low and high grade oligodendrogliomas showed characteristic choline/creatine and alanine/creatine metabolite ratios. The spectroscopical characterization of histopathological factors concerning malignant gliomas is shown.     

Antigenic heterogeneity of human brain tumors defined by monoclonal antibodies

The antigenic profiles of human gliomas and in vitro established cell lines were investigated using the monoclonal antibodies (MABs) MUC 8-22 and MUC 2-63. The reactivity with tissue samples and cytospin preparations obtained from 45 brain tumors was estimated by the indirect immunoperoxidase technique. In addition, computer-assisted cytofluorometry was used to quantify the intensity and distribution of antibody-binding. Various degrees of antibody-binding among and within gliomas and glioma-derived cell lines were observed. The data show that a variable percentage of cells are not labeled with the employed MABs. The spectrum of reactivity of the selected antibodies was independent of the histological grading of gliomas. However, there were significant differences in various stages of subcultivation of glioma lines. In most cases, the heterogeneity of antigen expression decreased during successive in vitro propagation of glioma cells. The extent of variation in staining intensity values differed within cell populations and reflected the antigenic heterogeneity of human brain tumors. The findings presented here suggest that the use of MABs which recognize glioma-associated antigens facilitates the objective analysis of brain tumors and is of potential value for immunohistochemical application in surgical neuropathology.     

Potential role for magnetoencephalography in distinguishing low- and high-grade gliomas: a preliminary study with histopathological confirmation

Gliomas are the most common form of tumor in the CNS and are exceptionally heterogeneous. Accurately characterizing gliomas, in terms of grade and type, is essential for predicting the rate of tumor progression. Histopathological grading and analysis based on biopsied tissue remains the gold standard, but non- and semi-invasive neuroimaging also plays a key role. Neuroimaging has been used to guide and optimize biopsies for several decades, but more recently molecular imaging and variants of MRI have shown promise in independently predicting glioma grade. Here we evaluated whether magnetoencephalographic (MEG) measurements of population-level physiology within the glioma space were predictive of the inherent grade of the tissue, based on definitive histopathological analyses. High-density MEG data were recorded from 11 patients who were undergoing functional mapping in preparation for resective surgery. The primary results indicated that glioma grade was positively correlated with the local amplitude of activity within the glioma space in the theta (4-7 Hz), alpha (8-14 Hz), and beta bands (14-30 Hz). Additionally, activity within the glioma was significantly elevated relative to the nonaffected homologue area in the same frequency bands. These results indicate that pathological levels of synchronization exist within the tumor space and that MEG may be a viable tool for noninvasively differentiating gliomas by their grade. Although these results should be considered preliminary and are only correlative in nature, these data suggest that MEG can potentially detect neurophysiological signatures or markers that predict the inherent grade of a glial tumor.     

分子影像学在神经胶质瘤的诊断与治疗中的应用

分子影像学是医学影像技术和分子生物学相结合的学科，利用现有的一些医学影像技术，如核医学（PET）、核磁共振（MRI）和光学成像方法（OCT）．对人体内部生理或病理过程在分子水平上进行无损伤的、实时的成像，对神经胶质瘤的诊断和治疗是分子影像学研究的一大方面，全文就分子影像学的原理及技术、分子影像学在胶质瘤诊疗中的应用加以综述。