31P MR波谱在骨恶性肿瘤与炎症鉴别中的应用

目的 探讨活体31P MR波谱(31P MRS)在骨恶性肿瘤与炎症鉴别中的价值.方法 对32名健康志愿者、20例恶性骨肿瘤、22例骨及软组织炎症患者分别行常规X线、MRI与31P MRS 检查,测定波谱中各代谢产物的峰下面积,计算各代谢产物间的比值,并根据无机磷(Pi)相对于磷酸肌酸(PCr)的化学位移测定细胞内pH值.统计学采用单因素方差分析.结果 31P MRS检测发现恶性骨肿瘤组磷酸单酯(PME)/β-三磷酸腺苷(ATP)值(1.24±0.37)明显高于对照组和炎症组(P值均＜0.01);炎症组磷酸二酯(PDE)/β-ATP(2.21±0.37)、Pi/β-ATP(1.46±0.43)明显高于对照组和恶性肿瘤组(P值均＜0.05),但PME/β-ATP(0.19±0.10)值不高;对照组低能磷酸盐(LEP)/总31P代谢物(T31P)(0.10±0.02)、PCr/T31p(0.45±0.03)、ATP/T31P(0.45±0.03)与恶性骨肿瘤和炎症组之间差异有统计学意义(P值均＜0.01);恶性肿瘤组细胞内pH值为7.45±0.16,明显高于正常对照组(7.05±0.06)和炎症组(7.20±0.13)(P值均＜0.01).结论 组织中PME和细胞内pH值的升高对恶性骨肿瘤的诊断有重要意义.MRS技术与常规X线、MRI相结合,有助于临床对恶性骨肿瘤与炎症的鉴别.

The application study of 31P MR spectroscopy on differential diagnosis of bone malignancy and inflammation

Objective To explore the value of 31P magnetic resonance spectroscopy(31P MRS)for differential diagnosis of bone malignancy and inflammation.Methods Radiography.MRI and 31P MRs were performed on 20 bone malignancy patients,22 bone and soft-tissue inflarnmation patients and 32 healthy voluntecrs.The spectra were analyzed by measuring the areas under the peaks of various metabolites,and by calculating the pH from the Pi shift relative to PCr.The data were analyzed by one-way analysis of vailance (ANOVA).Results Analysis of the 31P MRS data suggested differences among the bone malignancy,the inflammation and the healthy group.The mean of PME/β-ATP ratio(1.24±0.37)in malignancy group increased significantly(P＜0.01).The mean of PDE/β-ATP(2.21.±0.37),Pi/β-ATP(1.46±0.43)in inflammation group was higher than that of the other two groups(P＜0.05),but the ratio of PME/β-ATP (0.19±0.10)wag not increasing.The LEP/T31P(0.10±0.02),PCr/T31P(0.45±0.03)and ATP/T31P (0.45±0.03)ratios in control group were significantly difierent from the two others(P＜0.01).The mean of intracellular pH in malignancy group was 7.45±0.16,higher than that in control group(7.05±0.06),and in inflaruination group(7.20±0.13)(P＜0.01).Conclusions The significant increase of PME and intraeellular pH is of great value in diagnosis of bone malignancy.Combined conventional radiography and MRI.31PMRs would be a simple,no-.invasive and effective diagnostic method.